Deterioration after intubation: Difference between revisions
| Line 13: | Line 13: | ||
==Management== | ==Management== | ||
===Troubleshoot=== | ===Troubleshoot=== | ||
''Immediately disconnect from ventilator (allows for expiration of stacked breaths)'' | |||
*D - Displacement of tube | *D - Displacement of tube | ||
**Attach end-tidal CO2 to verify and check depth (cm at lip) | **Attach end-tidal CO2 to verify and check depth (cm at lip) | ||
| Line 58: | Line 44: | ||
*Decrease TV | *Decrease TV | ||
*Increase sedation | *Increase sedation | ||
*When in doubt, disconnect the pt from the ventilator and begin bag ventilation | |||
**Eliminates the vent ('''E''') circuit as source of the problem | |||
**Helps gauge lung compliance | |||
*Airway | |||
**Is the tube still in? ('''D''') | |||
**Is it patent? ('''O''') | |||
**Auscultate and/or CXR | |||
*Breathing | |||
**Is the chest rising? Breath sounds equal b/l? ('''P''') | |||
***Lung sounds not always reliable → get CXR if continued clinical concern | |||
==See Also== | ==See Also== | ||
Revision as of 10:32, 26 August 2015
Background
Clinical Features
Differential Diagnosis
DOPE[1][2]
- Displaced ETT
- Obstruction (anywhere along circuit)
- Pneumothorax
- Equipment failure (ventilator malfunction or disconnect)
Diagnosis
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 pt not biting down
- P - Pneumothorax
- Verify via US
- E - Equipment failure
- Connect to BVM
- S - Stacked breaths - Auto-PEEP especially in COPD/Asthma pts
- Disconnect from ventilator
Fix
- Disconnect vent and put light pressure on pt 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 resp acidosis, which is harmful in pts with increased ICP or tox ingestion
- Sonography
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
- When in doubt, disconnect the pt from the ventilator and begin bag ventilation
- Eliminates the vent (E) circuit as source of the problem
- Helps gauge lung compliance
- Airway
- Is the tube still in? (D)
- Is it patent? (O)
- Auscultate and/or CXR
- Breathing
- Is the chest rising? Breath sounds equal b/l? (P)
- Lung sounds not always reliable → get CXR if continued clinical concern
- Is the chest rising? Breath sounds equal b/l? (P)
See Also
Mechanical Ventilation Pages
- Noninvasive ventilation
- Intubation
- Mechanical ventilation (main)
- Miscellaneous
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