EMERGENCIES IN CRITICAL CARE: Edited by Christopher W. SeymourAcute life-threatening hypoxemia during mechanical ventilationPiraino, Thomasa,b; Fan, Eddyc,dAuthor Information aDepartment of Anesthesia, McMaster University, Hamilton bDepartment of Respiratory Therapy, St. Michael's Hospital cDivision of Respirology, Toronto General Hospital, University Health Network and Sinai Health System dInterdepartmental Division of Critical Care Medicine and the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada Correspondence to Eddy Fan, MD, PhD, Division of Respirology, Toronto General Hospital, University Health Network and Sinai Health System, 585 University Avenue, PMB 11-123, Toronto, ON M5G 2N2, Canada. Tel: +1 416 340-5483; fax: +1 647 776-3148; e-mail: [email protected] Current Opinion in Critical Care: December 2017 - Volume 23 - Issue 6 - p 541-548 doi: 10.1097/MCC.0000000000000459 Buy Metrics Abstract Purpose of review To describe current evidence-based practice in the management of acute life-threatening hypoxemia in mechanically ventilated patients and some of the methods used to individualize the care of the patient. Recent findings Patients with acute life-threatening hypoxemia will often meet criteria for severe ARDS, for which there are only a few treatment strategies that have been shown to improve survival outcomes. Recent findings have increased our knowledge of the physiological effects of spontaneous breathing and the application of PEEP. Additionally, the use of advanced bedside monitoring has a promising future in the management of hypoxemic patients to fine-tune the ventilator and to evaluate the individual patient response to therapy. Summary Treating the patient with acute life-threatening hypoxemia during mechanical ventilation should begin with an evidence-based approach, with the goal of improving oxygenation and minimizing the harmful effects of mechanical ventilation. The use of advanced monitoring and the application of simple maneuvers at the bedside may assist clinicians to better individualize treatment and improve clinical outcomes. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.