Clinical Order for On ETT Endotracheal Intubation and Ventilation

• 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.