| Common causes | Important clinical findings | Interventions | Prevention and preparation |
| ETT malposition (dislodged; esophageal placement) | - Bilateral decreased breath sounds
- Gastric breath sounds (esophageal intubation)
- Low PIP
| | |
| Mainstem intubation | - Asymmetric breath sounds
- High resistance to BMV
- High PIP
| - Withdraw ETT appropriate distance and recheck breath sounds
| - Insert ETT appropriate distance
- Keep ETT well secured
|
| ETT cuff malfunction | - Ventilator leak or low ventilation volumes
- Loss of pilot balloon pressure
| | - Inflate and check cuff of primary and backup ETT prior to intubation
|
| Mucus plugging | - Increased secretions
- High resistance to BMV
- High PIP
| | - Suction frequently if heavy secretions
|
Rapid desaturation
(causes: obesity, late term pregnancy, inadequate preoxygenation, intrapulmonary shunt [eg, ARDS, pneumonia]) | - Sudden drop in oxygen saturation very soon after induction and neuromuscular blockade
| - Rescue mask ventilation with oral and nasal airways
- Rescue extraglottic device
| - Maximize preoxygenation:
- Upright sitting (if no concern for c-spine injury) or reverse Trendelenburg position
- Flush-rate oxygen
- BiPAP and PEEP
- Continuous passive oxygenation
|
| Profound shock or anemia | - Specific findings vary with cause; refer to UpToDate topics and graphics on rapid sequence intubation
| | |
| Pneumothorax | - Asymmetric breath sounds
- Subcutaneous emphysema
- High resistance to BMV
- High PIP
| - Needle thoracostomy (temporizing)
- Tube thoracostomy
| - 18 gauge needle or chest tube kit at the bedside for high-risk patients
|
| Oxygen apparatus malfunction | - Hypoxemia unexplained by clinical findings
| - Confirm oxygen source functioning, connections secure, and tubing intact
| |
