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Clinical Order for On ETT Endotracheal Intubation and Ventilation

Writer: MaytaMayta
Dec 9, 20242 min read

  • On ETT No. 7.5, Mark 21

  • On PAC Mode

    • PIP: 14 cmH₂O, PEEP: 5 cmH₂O, RR: 14 breaths/min, FiO₂: 0.4 , Ti: 1.0 second

  • Keep SpO₂ ≥ 94%

Patient Ventilation Management:

This article outlines a clear and concise method for placing and managing an endotracheal tube (ETT) in conjunction with a pressure-assisted controlled (PAC) ventilator mode.

Clinical Order:

  1. Endotracheal Tube (ETT) Placement:

    • ETT Size: No. 7.5 mm

    • Positioning: Inserted and secured at Mark 21 cm at the lip

    • Confirm placement with:

      • Capnography (end-tidal CO₂)

      • Auscultation of bilateral lung sounds

      • Chest X-ray for tube position verification

  2. Mechanical Ventilator Settings (PAC Mode):

    • Mode: Pressure-Assisted Control (PAC)

    • Peak Inspiratory Pressure (PIP): 14 cmH₂O

    • Positive End-Expiratory Pressure (PEEP): 5 cmH₂O

    • Respiratory Rate (RR): 14 breaths per minute

    • FiO₂: 0.4 (40% inspired oxygen fraction)

    • Inspiratory Time (Ti): 1.0 second

  3. Oxygenation Target:

    • Goal: Maintain SpO₂ (oxygen saturation) ≥ 94%

  4. Monitoring and Adjustments:

    • Monitor SpO₂ continuously to maintain ≥ 94%.

    • Perform arterial blood gas (ABG) analysis after 30 minutes of initiation to assess oxygenation and ventilation adequacy.

    • Adjust FiO₂ gradually to the lowest level required to achieve the SpO₂ target, minimizing the risk of oxygen toxicity.

    • Regularly reassess ventilator settings based on patient condition and ABG results.

  5. Additional Care Measures:

    • Ensure ETT cuff pressure remains between 20-30 cmH₂O to prevent air leaks and aspiration.

    • Secure ETT with appropriate fixation to avoid accidental displacement.

    • Maintain airway patency by suctioning as necessary, and observing sterile technique.

  6. Documentation:

    • Record the procedure, ventilator settings, and SpO₂ target in the patient’s medical record.

    • Note any complications during intubation or ventilation initiation, if present.

Rationale:

This order provides a structured approach for initiating invasive mechanical ventilation in critically ill patients requiring respiratory support. The specified PAC mode settings aim to optimize oxygenation while minimizing the risk of barotrauma and oxygen toxicity. Regular monitoring ensures patient safety and adaptability of treatment to the patient’s clinical response.

Key Points for Practitioners:

  • Verify the placement of ETT using both clinical and imaging modalities.

  • Optimize ventilator settings to ensure adequate oxygenation and ventilation while preventing complications.

  • Continuously reassess and adjust settings based on the patient's progress and clinical data.

This article serves as a guide for healthcare providers to implement the prescribed order effectively, ensuring quality patient care.

 
 
 

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Post: Blog2_Post

Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

One key difference is in patient access. In Thailand, patients can walk directly into tertiary care centers without going through a referral system or primary care gatekeeping. This creates an intense clinical workload for doctors and trainees alike. From the age of 20, I was already seeing real patients, performing procedures, and assisting in operations—not in simulations, but in live clinical situations. Long work hours, sometimes exceeding 48 hours without sleep, are considered normal for young doctors here.
 

Many of the insights I share are based on first-hand experiences, feedback from attending physicians, and real clinical practice. In our culture, teaching often involves intense feedback—what we call "โดนซอย" (being sliced). While this may seem harsh, it pushes us to grow stronger, think faster, and become more capable under pressure. You could say our motto is “no pain, no gain.”
 

Please be aware that while my articles may contain clinically accurate insights, they are not always suitable as direct references for academic papers, as some content is generated through AI support based on my knowledge and clinical exposure. If you wish to use the content for academic or clinical reference, I strongly recommend cross-verifying it with high-quality sources or databases. You may even copy sections of my articles into AI tools or search engines to find original sources for further reading.
 

I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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