Ventilator desaturation

• Immediately disconnect from ventilator (allows for expiration of stacked breaths)
• "DOPES like DOTTS" Mnemonic

Troubleshoot

• • 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

See Also

• Ventilation (Main)