Lessons in Transport - Post-Intubation Checklists

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"Whatever is worth doing at all is worth doing well." - Lord Chesterfield  

Post-Intubation Checklists

Making a checklist can help cognitively unload you in high stakes and high pressure situations.  Post-intubation consider the following important points:

Protecting the Tube

  • Continuous wave form ETCO2... each and every time

  • Secure Endotracheal Tube at the appropriate depth (See LIT week 6)

  • Analgesia and Sedation

  • Restraints... Do you know where the soft restraints are stored?

Protecting the Lungs

  • Ventilator Settings (Protective Lung Strategy): TV 6-8cc/kg ideal body weight

  • Ventilator Plateau Pressure < 30 cm H2O

  • Titrate down FiO2 as able for goal O2 sats > 92%

  • Head of Bed elevated to help prevent ventilator associated pneumonia

  • NG/OG placement to decompress the stomach to aide respiratory mechanics and prevent aspiration

Don't Forget:  Treat the underlying pathology requiring intubation

When possible, consider the following:

  • Checking the endotracheal tube cuff pressure (ideal pressure is between 20-30cm H2O)

  • Humidify the air

  • Placing in-line suction

  • Nebulizers/MDI as indicated

***PEARL*** Have a BVM with face mask and PEEP valve at the head of the bed... Just in case you need it!!!

For more information, including an example checklists, check out http://emcrit.org/podcasts/post-intubation-package/

Author: Ryan Gerecht, MD CMTE & Diana Deimling, RN, BSN