A patient remains hypoxic while receiving supplemental oxygen at FIO2 0.45 by air-entrainment device. What should the respiratory therapist recommend?

When a patient remains hypoxic despite receiving supplemental oxygen at an FIO2 of 0.45 via an air-entrainment device, the logical recommendation is to increase the FIO2. This is because the existing FIO2 of 0.45 may not be sufficient to adequately improve the patient's oxygen saturation levels.

Increasing the FIO2 can enhance the oxygen delivery to the alveoli, thereby increasing the amount of oxygen that enters the bloodstream. This action is particularly vital in cases of hypoxia where the patient’s oxygenation status needs urgent improvement. Supplemental oxygen therapy aims to reach a FIO2 that is adequate for the patient’s clinical condition, and if the current level is not achieving this, raising the FIO2 is a direct intervention that can be implemented.

While other options like mechanical ventilation or CPAP could potentially improve oxygenation, they are more invasive procedures and may not be warranted unless there are signs of severe respiratory failure or other indications for advanced support. Reducing the FIO2 would further decrease the oxygen available to the patient, which would not be helpful in managing hypoxia. Therefore, the most appropriate and immediate action in this scenario is to recommend an increase in FIO2.