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Deterioration after intubation
From WikEM
Contents
Background
Clinical Features
- Desaturation, other vital sign abnormalities, or full arrest while on mechanical ventilation
Differential Diagnosis
DOPE[1][2]
- Displaced ETT
- Obstruction (anywhere along circuit)
- Pneumothorax
- Equipment failure (ventilator malfunction or disconnect)
Evaluation
- Clinical
Management
Troubleshoot
Immediately disconnect from ventilator (allows for expiration of stacked breaths)
- D - Displacement of tube
- Attach end-tidal CO2 to verify and check depth (cm at lip)
- O - Obstruction of tube/circuit
- Use suction catheter to remove mucus plug, or make sure patient not biting down
- P - Pneumothorax
- Verify via ultrasound, CXR, or needle thoracostomy (high suspicion)
- E - Equipment failure
- Connect to BVM
- S - Stacked breaths - Auto-PEEP especially in COPD/Asthma
- Disconnect from ventilator
Fix
- Disconnect ventilator and put light pressure on patient chest
- Oxygen 100%
- Bag and take time to evaluate your patient
- Tube Position & Function
- Pass bougie or suction all the way through the tube, OR take a look with DL
- Tweak Vent Settings
- Drop TV, then decrease RR, and then increase flow rate
- Caution as it causes hypercapnia and respiratory acidosis, which is harmful in patients with increased ICP or tox ingestion
- Sonography and CXR
Auto-PEEP (Breath stacking) troubleshooting options
- Bronchodilators if COPD/asthma
- Decrease RR
- Decrease I:E ratio (increase expiratory time)
- Quicker inspiratory flow rate
- Decrease TV
- Increase sedation
See Also
Mechanical Ventilation Pages
- Noninvasive ventilation
- Intubation
- Deterioration after intubation
- Ventilation settings
- Ventilation modes
- Ventilator high pressures
- Ventilator associated lung injury (VALI)
- Recruitment maneuver
- Ventilation weaning
- Extubation
References
- ↑ EMRA Critical Care Handbook
- ↑ Monica E. Kleinman et al. Pediatric Advanced Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. AAP. 2010. http://pediatrics.aappublications.org/content/126/5/e1361.full
