Deterioration after intubation - Revision history

Rossdonaldson1: /* Disposition */

2026-04-15T20:56:05Z

Disposition

← Older revision		Revision as of 20:56, 15 April 2026
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	==Disposition==		==Disposition==
	*~~All intubated patients require~~ ICU ~~admission~~		*Typically ICU
	*If deterioration occurs post-intubation, systematically evaluate using DOPES mnemonic
	*Consider transfer to higher level of care if unable to identify and correct cause
	*Surgical consultation if pneumothorax or other surgical emergency identified

	==See Also==		==See Also==

Danbot: Add evidence-based Disposition section

2026-03-22T10:03:59Z

Add evidence-based Disposition section

← Older revision		Revision as of 10:03, 22 March 2026
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	{{Lung Protective FiO2 and PEEP Scale}}		{{Lung Protective FiO2 and PEEP Scale}}

			==Disposition==
			*All intubated patients require ICU admission
			*If deterioration occurs post-intubation, systematically evaluate using DOPES mnemonic
			*Consider transfer to higher level of care if unable to identify and correct cause
			*Surgical consultation if pneumothorax or other surgical emergency identified

	==See Also==		==See Also==

Rossdonaldson1 at 16:10, 24 April 2024

2024-04-24T16:10:25Z

← Older revision		Revision as of 16:10, 24 April 2024
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	*High Peak and High Plateau - Compliance issue (pneumothorax, problem with alveoli like ARDS, fluid overload). Need to decrease pressure to prevent barotrauma.		*High Peak and High Plateau - Compliance issue (pneumothorax, problem with alveoli like ARDS, fluid overload). Need to decrease pressure to prevent barotrauma.
	*Plateau pressures should be kept < 30mmHg if possible.		*Plateau pressures should be kept < 30mmHg if possible.
	[[File:ardsnet.jpg\|thumb]]		[[File:ardsnet.jpg\|thumb\|[http://www.ardsnet.org/files/ventilator_protocol_2008-07.pdf ARDS net ventilator protocol ]]]
	http://www.ardsnet.org/files/ventilator_protocol_2008-07.pdf

	{{Lung Protective FiO2 and PEEP Scale}}		{{Lung Protective FiO2 and PEEP Scale}}

Rossdonaldson1: /* See Also */

2024-04-10T21:05:07Z

Elcatracho: /* Clinical Features */

2022-04-26T05:27:06Z

Clinical Features

← Older revision		Revision as of 05:27, 26 April 2022
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	==Clinical Features==		==Clinical Features==
	*Desaturation, other vital sign abnormalities, or cardiac arrest while on mechanical ventilation		*Desaturation, other vital sign abnormalities, or [[cardiac arrest]] while on mechanical ventilation

	==Differential Diagnosis==		==Differential Diagnosis==

Elcatracho: /* DOPEEMRA Critical Care HandbookMonica 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.or...

2020-11-25T23:11:53Z

/* DOPEEMRA Critical Care HandbookMonica 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.or...

← Older revision		Revision as of 23:11, 25 November 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	===~~DOPE~~<ref>EMRA Critical Care Handbook</ref><ref>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</ref>===		===DOPES<ref>EMRA Critical Care Handbook</ref><ref>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</ref>===
	*'''D'''isplaced ETT		*'''D'''isplaced ETT
	*'''O'''bstruction (anywhere along circuit)		*'''O'''bstruction (anywhere along circuit)
	*[[Pneumothorax\|'''P'''neumothorax]]		*[[Pneumothorax\|'''P'''neumothorax]]
	*'''E'''quipment failure (ventilator malfunction or disconnect)		*'''E'''quipment failure (ventilator malfunction or disconnect)
			*'''S'''tacked breaths (asthmatics)

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Peak Vs Plateau Pressure */

2020-03-21T21:54:25Z

Peak Vs Plateau Pressure

← Older revision		Revision as of 21:54, 21 March 2020
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	[[File:ardsnet.jpg\|thumb]]		[[File:ardsnet.jpg\|thumb]]
	http://www.ardsnet.org/files/ventilator_protocol_2008-07.pdf		http://www.ardsnet.org/files/ventilator_protocol_2008-07.pdf

	~~[[File:ardsnet2.png\|thumb]]~~
	~~Vent basics resource: https://emcrit.org/wp-content/uploads/2010/05/Managing-Initial-Vent-ED.pdf~~

	{{Lung Protective FiO2 and PEEP Scale}}		{{Lung Protective FiO2 and PEEP Scale}}

Rossdonaldson1: /* Peak Vs Plateau Pressure */

2020-03-21T21:53:59Z

Peak Vs Plateau Pressure

← Older revision		Revision as of 21:53, 21 March 2020
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	[[File:ardsnet2.png\|thumb]]		[[File:ardsnet2.png\|thumb]]
	Vent basics resource: https://emcrit.org/wp-content/uploads/2010/05/Managing-Initial-Vent-ED.pdf		Vent basics resource: https://emcrit.org/wp-content/uploads/2010/05/Managing-Initial-Vent-ED.pdf

			{{Lung Protective FiO2 and PEEP Scale}}

	==See Also==		==See Also==

Rossdonaldson1: /* Auto-PEEP (Breath stacking) troubleshooting options */

2020-03-21T21:51:10Z

Auto-PEEP (Breath stacking) troubleshooting options

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 *Decrease TV
 *Increase sedation
 ==See Also==

Rossdonaldson1 at 21:48, 21 March 2020

2020-03-21T21:48:50Z

← Older revision		Revision as of 21:48, 21 March 2020
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	===Troubleshoot===		===Troubleshoot===
	''Immediately disconnect from ventilator (allows for expiration of stacked breaths)''		''Immediately disconnect from ventilator (allows for expiration of stacked breaths)''
	*D - Displacement of tube		*D - Displacement of tube or cuff
	**Attach end-tidal CO2 to verify and check depth (cm at lip)		**Attach end-tidal CO2 to verify and check depth (cm at lip)
	*O - Obstruction of tube/circuit		*O - Obstruction of tube/circuit
	**Use suction catheter to remove mucus plug, or make sure patient not biting down		**Use suction catheter to remove mucus plug, or make sure patient not biting down, look for kink in tube
	*P - Pneumothorax		*P - [[Pneumothorax]]
	**Verify via [[Ultrasound: Lungs\|ultrasound]], CXR, or [[needle thoracostomy]] (high suspicion)		**Verify via [[Ultrasound: Lungs\|ultrasound]], CXR, or [[needle thoracostomy]] (high suspicion)
	*E - Equipment failure		*E - Equipment failure
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	*O - Oxygen 100% BVM. Look for chest rise, listen and feel for cuff leak		*O - Oxygen 100% BVM. Look for chest rise, listen and feel for cuff leak
	*T - Tube position and patency. Pass bougie or suction all the way through tube to remove obstruction		*T - Tube position and patency. Pass bougie or suction all the way through tube to remove obstruction
	*T - Tweak the vent. Usually need to decrease respiratory rate (see below on breath-staking)		*T - Tweak the vent. Usually need to decrease respiratory rate, decreased inspiratory time with changing E:I ratio (see below on breath-staking)
	*S - Sonography and CXR		*S - Sonography and CXR

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	==See Also==		==See Also==
	{{Mechanical ventilation pages}}		{{Mechanical ventilation pages}}

			==External Links==
			*https://rebelem.com/rebel-cast-ep-46b-vent-management-crashing-patient-haney-mallemat/

	==References==		==References==
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	[[Category:Pulmonary]]		[[Category:Pulmonary]]
	[[Category:Critical Care]]		[[Category:Critical Care]]

	~~(https://rebelem.com/rebel-cast-ep-46b-vent-management-crashing-patient-haney-mallemat/)~~
	**DOPES = Displaced ET tube or cuff, Obstructed ET tube: pt biting tube, kink in tube, mucous plug, Pneumothorax, Equipment: Tube from ETT to Vent, Stacked breaths: auto-PEEP (typically asthma/COPD, results from decreased ability to expire air)
	**DOTTS = Disconnect from vent (can push down on pt’s chest if concern for auto-PEEP), FOR COVID-19 SKIP Oxygenate with 100% BVM (evaluates for ETT dislodgement, bilateral breath sounds, cuff leak, crepitus, difficulty bagging), Tube check for mucous plug or kink or dislodgement, Tweak vent for autoPEEP (decreased RR, decreased inspiratory time with changing E:I ratio), Sonography for pneumothorax.

← Older revision		Revision as of 21:05, 10 April 2024
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	==See Also==		==See Also==
	{{Mechanical ventilation pages}}		{{Mechanical ventilation pages}}
			{{Related Difficult Airway Pages}}

	==External Links==		==External Links==