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Explain Intubation and Ventilation ?
If supplemental oxygen therapy or non-invasive ventilation do not help, the next step would be to intubate and commence mechanical ventilation. The decision to intubate is made primarily on clinical grounds, but broad guidelines may be as below: Indications for Intubation and Ventilation
Breathlessness, tachypnoea with respiratory rate more than 30/mt
Use of accessory muscles
Tachycardia
Hypoxia - PO2 less than 60 mm of Hg while on maximal oxygen therapy
Hypercarbia
Respiratory muscle weakness - Polyneuropathy, myasthenia, etc.
Agitation, restlessness due to difficulty in breathing/ hypoxia
Inability to maintain airway, cough and clear secretions
Altered sensorium
Intubation can be carried out in most situations after a short IV anaesthetic and a rapid onset muscle relaxant ( see protocol). Hypovolemic patients tolerate anesthetic drugs and positive pressure ventilation poorly, hence a fluid bolus prior to intubation may be required. Blood pressure may drop subsequent to intubation and mechanical ventilation, this may require more fluid resuscitation or inotrope/vasopressor support.
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