1. Ventilator Settings:
i. Adjust based on patient needs (e.g., volume vs. pressure control).
ii. Set appropriate tidal volume (6-8 mL/kg ideal body weight).
iii. Adjust FiO2 and PEEP to maintain oxygenation.
2. Sedation and Analgesia:
Initiate continuous sedation (e.g., propofol, midazolam) and analgesia (e.g., fentanyl) to prevent patient discomfort and agitation.
3. Monitoring:
i. Continuous ECG, SpO2, EtCO2, BP.
ii. Monitor ventilator parameters (peak pressures, volumes).
4. Diagnostic Tests:
- Chest X-ray:
- Confirm tube placement (2-5 cm above carina), assess for complications.
- Arterial Blood Gas (ABG):
- Assess oxygenation, ventilation, acid-base status.
5. Ongoing Care:
i. Reassess sedation: Adjust as needed.
ii. Prevent Ventilator-Associated Events:
- Elevate head of bed to 30-45 degrees.
- Oral hygiene.
- Gastric ulcer prophylaxis.
- DVT prophylaxis.
6. Communication:
Update family and document the procedure, tube size, depth, and patient's response.
Additional Notes
- Plan for disposition: ICU admission, arrange transport if necessary.
- Consider prophylactic measures: Stress ulcer and DVT prophylaxis as per protocol.