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Troubleshooting review

Hypoxia: stacking / auto-PEEP

Air trapping can worsen oxygenation and cause hypotension.

See auto-PEEP waveformFlow not returning to baseline.Ventilator timing referenceEstimate expiratory time.If MAP fallsAuto-PEEP shock.

Act

  • Bag slowly; allow full exhalation.
  • Lower RR and shorten inspiratory time/increase inspiratory flow as appropriate.
  • Treat bronchospasm and dyssynchrony.
  • Consider brief disconnect if crashing and air trapping is suspected.

Evidence and use limits

Last reviewed: 2026-07-23. Designed for: emergency medicine learners, clinicians, EMS, RT, and airway educators.

This is an educational clinical reference, not a bedside order set. Confirm medications, ventilator changes, pediatric dosing, procedures, and escalation decisions against the patient’s physiology, the ventilator in use, and local ED/ICU/anesthesia/pharmacy/RT/EMS/pediatric policy.

Full references · Editorial policy · AARC 2024 ventilator assessment · ATS/ESICM/SCCM lung-protective ventilation · ATS 2024 ARDS update

About this resource
Created by: Kyle Brown MD; Andrew Pirotte, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: EM faculty Reviewed: local ED, ICU, EMS, anesthesia, pharmacy, and pediatric protocol review recommended before bedside teaching rollout. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and clinical-reference guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: kybrown@kumc.edu