Step 4
Post-Airway
Confirm the tube, secure it, set the ventilator, start analgesia/sedation, and complete follow-up.
Critical actions
Tube confirmation
Continuous waveform capnography is the primary confirmation and ongoing displacement monitor when a perfusing rhythm is present.
Plan to say: Waveform is ___. Tube depth is ___. Reconfirmation trigger is ___.
Optional cognitive support. Choose the option that fits the patient, local equipment, team skill, and protocol.
Secure
Tube security is a continuing process, especially during transport and repositioning.
Plan to say: Depth is __ at __. Securement is __. Circuit is supported by ___.
Optional cognitive support. Choose the option that fits the patient, local equipment, team skill, and protocol.
Gastric-tube placement is not automatic; use it when decompression, medication delivery, feeding planning, or reduced gastric insufflation is clinically useful.
Plan to say: Gastric tube is indicated for ___. Route is ___. Verification method is ___.
Optional cognitive support. Choose the option that fits the patient, local equipment, team skill, and protocol.
Ventilation
Initial settings are a starting point; the required plan differs for ARDS/shunt, obstructive disease, severe acidosis, and normal lungs.
Plan to say: Mode is ___. VT is ___. RR is ___. PEEP/FiO₂ is ___. Reassessment is at ___.
Optional cognitive support. Choose the option that fits the patient, local equipment, team skill, and protocol.
Sedation / analgesia
Neuromuscular blockade provides neither analgesia nor amnesia.
Plan to say: Analgesic is ___. Bolus is ___. Maintenance is ___. Reassessment sign is ___.
Optional cognitive support. Choose the option that fits the patient, local equipment, team skill, and protocol.
Use an explicit target and ensure the plan covers the full duration of paralysis.
Plan to say: Sedative is ___. Target is ___. Bolus/infusion is ___. Reassessment is ___.
Optional cognitive support. Choose the option that fits the patient, local equipment, team skill, and protocol.
Post-intubation deterioration is often recognizable before the full diagnosis is known.
Plan to say: Current failure signal is ___. Immediate action is ___. Working bucket is ___.
Optional cognitive support. Choose the option that fits the patient, local equipment, team skill, and protocol.
Follow-up
The value is useful only when timing and the clinical question are clear.
Plan to say: The gas question is ___. If PaCO₂/pH is __, we will change ___.
Optional cognitive support. Choose the option that fits the patient, local equipment, team skill, and protocol.
Chest radiography does not replace continuous waveform capnography for initial tube confirmation.
Plan to say: Imaging indication is ___. Immediate concern that cannot wait is ___.
Optional cognitive support. Choose the option that fits the patient, local equipment, team skill, and protocol.
Pearls
- The airway is not complete at tube passage. Immediate confirmation, analgesia/sedation, ventilator setup, hemodynamic reassessment, and follow-up prevent avoidable post-intubation harm.
- Say aloud: The ETT is confirmed with continuous waveform capnography and secured. OG/NG placement is addressed. Vent settings are verbalized and confirmed. Analgesia and sedation are active. Hemodynamics and oxygenation are reassessed. Blood gas and chest imaging will be obtained when indicated.
Pitfalls
- Relying on auscultation without waveform capnography
- Leaving a paralyzed patient without analgesia and sedation
- Vent settings not verbalized or reassessed
- Post-intubation hypotension or hypoxia ignored
- Treating blood gas or chest X-ray as automatic rather than indication- and context-dependent follow-up