If the patient also still has clinically significant hypoxemia despite deep sedation with or without paralysis and the circuit is functioning properly, consider:

• A red blood cell (RBC) transfusion.
• Therapeutic hypothermia to decrease metabolic demand.
• Paralysis to decrease metabolic demand and decrease the work for breathing.
• Beta blockade to decrease native cardiac output (CO).
  • Use with caution as decrease in CO may reduce systemic oxygen delivery (DO2).
• Prone positioning if it’s safe and feasible, depending on the patient’s situation.