1. Disconnect ventilator tubing from ET tube and manually ventilate Pt.
2. Have RT/physician notified STAT if not already done.

Patient Is Easy to Manually Ventilate

1. Ventilator is probable source of problem. Notify RT.
2. Manually ventilate Pt while RT assesses ventilator.

Patient Is Difficult to Manually Ventilate

• Dislodgement: If tube dislodged, remove and manually ventilate Pt. Suction oropharynx to clear secretions.
• Obstruction: Suction ET tube to clear secretions. Notify RT. If unable to clear obstruction or pass suction catheter, extubate and manually ventilate (suction oropharynx as needed to clear secretions).
• Pneumothorax: If ineffective ventilation continues after airway, ET, and ventilator are all determined to be patent, inspect and auscultate Pt’s chest. If there is unequal chest wall movement and/or decreased air movement on one side, it may be related to a tension pneumothorax (other causes may include an incorrectly positioned ET tube or atelectasis).
• Equipment: Inspect cuff for air leak (check cuff pressure if manometer available). Notify RT/physician if air leak cannot be fixed.

If ineffective ventilation continues and no physical or mechanical cause can be found, consider sedating Pt.

Ventilator Alarms

Alarm	Common Causes and Interventions
Low-Pressure	Causes: System disconnects or leaks. Reconnect Pt to ventilator. Evaluate cuff and reinflate if needed (if ruptured, tube must be replaced). Evaluate connections and tighten, or replace as needed. Check ET tube placement (auscultate lung fields and assess for equal, bilateral breath sounds).
High-Pressure	Causes: Resistance within the system such as a kink or water in the tubing, Pt biting ET tube, copious secretions, or plugged ET tube. Suction Pt if secretions suspected. Insert bite block as needed. Reposition Pt’s head and neck, or reposition tube. Sedation may be required to prevent Pt from fighting vent, but only after you exclude physical or mechanical causes.
High Respiratory Rate	Causes: Anxiety or pain, secretions in ET tube or airway, or hypoxia. Suction Pt. Look for source of anxiety (i.e., pain, environmental stimuli, inability to communicate, restlessness). Evaluate oxygenation.
Low Exhaled Volume	Causes: Tubing disconnect or inadequate seal. Evaluate/reinflate cuff; if ruptured, ET tube must be replaced. Evaluate connections; tighten or replace as needed; check ET tube placement, reconnect to ventilator.