DOI: 10.12890/2024_004976

Paradoxical hypoxemia following positive pressure ventilation: exploring the pathophysiology

Authors

  • Xin Ya See Department of Medicine, Unity Hospital, Rochester Regional Health, Rochester, USA
  • Zehra Naseem Department of Medicine, Cleveland Clinic Foundation, Cleveland, USA
  • Susan Synderburn Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, USA
  • William Wallace Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, USA
  • Neal Chaisson Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, USA
  • Daniel A. Culver Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, USA

xyxinyasee@gmail.com

Keywords

Hypoxemia, positive pressure ventilation, patent foramen ovale, shunt

Abstract

Positive pressure ventilation (PPV), both non-invasive and invasive, enhances ventilation but can sometimes lead to unexpected hypoxemia. This case report describes an instance of paradoxical hypoxemia after initiating bilevel positive airway pressure (BiPAP) in a 58-year-old female with a medical history of systemic lupus erythematosus, interstitial lung disease, and pulmonary embolism. BiPAP was started, leading to improved hypercarbia but worsened hypoxemia. Further investigation revealed a right-to-left interatrial shunt via a small patent foramen ovale (PFO). Adjusting BiPAP settings improved arterial blood gas parameters. This case illustrates how positive pressure ventilation with underlying PFO can cause paradoxical hypoxemia. The case emphasizes the importance of understanding the pathophysiology and tailoring BiPAP settings based on individual haemodynamics.

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References

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Published

2024-10-30

Issue

Vol. 11 No. 11 (2024)

Categories

How to Cite

1.
See XY, Naseem Z, Synderburn S, Wallace W, Chaisson N, Culver D. Paradoxical hypoxemia following positive pressure ventilation: exploring the pathophysiology. EJCRIM [Internet]. 2024 Oct. 30 [cited 2026 Nov. 3];11(11). Available from: https://ejcrim.com/index.php/ejcrim/article/view/4976

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