Approach to Managing Postoperative Hypoxemia - Flowchart
Approach to Managing Postoperative Hypoxemia - Flowchart Hypoxemia, Postoperative Hypoxemia, Postoperative
«Flowchart»

Postoperative hypoxia

Postoperative hypoxia

Postoperative hypoxia

First increase FIO2 and quickly assess hemodynamic stability. Then pursue cause of hypoxia

First increase FIO2 and quickly assess hemodynamic stability. Then pursue cause of hypoxia

First increase FIO2 and quickly assess hemodynamic stability. Then pursue cause of hypoxia

O 2

Reposition sensor

Reposition sensor

Reposition sensor

Continue to monitor

Continue to monitor

Continue to monitor

End

End

End

Intubated?

Intubated?

Intubated?

Yes

Yes

Yes

No

No

No

Place bite block, sedate patient

Place bite block, sedate patient

Place bite block, sedate patient

Make sure airway is correctly positioned, secured, cuff inflated, there are no air leaks, and there is expected exhaled tidal volume. Look for suggestive ventilator alarms

Make sure airway is correctly positioned, secured, cuff inflated, there are no air leaks, and there is expected exhaled tidal volume. Look for suggestive ventilator alarms

Make sure airway is correctly positioned, secured, cuff inflated, there are no air leaks, and there is expected exhaled tidal volume. Look for suggestive ventilator alarms

Patient biting ETT or thrashing?

Patient biting ETT or thrashing?

Patient biting ETT or thrashing?

Yes

Yes

Yes

No

No

No

Listen for audible and symmetric breath sounds

Listen for audible and symmetric breath sounds

Listen for audible and symmetric breath sounds

Suction airway

Suction airway

Suction airway

Consider pneumothorax, atelectasis, mucous plugging, large pleural effusion, main stem bronchus intubation

Consider pneumothorax, atelectasis, mucous plugging, large pleural effusion, main stem bronchus intubation

Consider pneumothorax, atelectasis, mucous plugging, large pleural effusion, main stem bronchus intubation

Monitor patient

Monitor patient

Monitor patient

Order chest x-ray, ABG. Increase FIO2 (consider increasing PEEP if intubated)

Order chest x-ray, ABG. Increase FIO2 (consider increasing PEEP if intubated)

Order chest x-ray, ABG. Increase FIO2 (consider increasing PEEP if intubated)

O 2

Consider severe upper airway obstruction

Consider severe upper airway obstruction

Consider severe upper airway obstruction

Listen for audible and symmetric breath sounds

Listen for audible and symmetric breath sounds

Listen for audible and symmetric breath sounds

Stridor

Stridor

Stridor

Yes

Yes

Yes

No

No

No

Cough, incentive spirometry

Cough, incentive spirometry

Cough, incentive spirometry

Asymmetric breath sounds?

Asymmetric breath sounds?

Asymmetric breath sounds?

Yes

Yes

Yes

No

No

No

Asymmetric breath sounds?

Asymmetric breath sounds?

Asymmetric breath sounds?

Yes

Yes

Yes

Disconnect from ventilator and manually ventilate. Feel for airway resistance

Disconnect from ventilator and manually ventilate. Feel for airway resistance

Disconnect from ventilator and manually ventilate.

Low pulse SaO2 or ABG PaO2?

Low pulse SaO2 or ABG PaO2?

Low pulse SaO2 or ABG PaO2?

O 2 O 2

SaO2

SaO2

O 2 SaO(2)

PaO2

PaO2

O 2 PaO(2)

Pulse SaO2 still low?

Pulse SaO2 still low?

Pulse SaO2 still low?

O 2

Yes

Yes

Yes

No

No

No

Improvement in SaO2?

Improvement in SaO2?

Improvement in SaO2?

O 2

Yes

Yes

Yes

No

No

No

Improvement in SaO2?

Improvement in SaO2?

Improvement in SaO2?

O 2

Yes

Yes

Yes

No

No

No