Step 4

Post-intubation

The airway is not done when the tube passes. Make the tube safe and the patient stable.

Critical actions

Sedation/analgesia active Vent mode/settings/alarms reviewed BP and shock physiology reassessed Tube depth documented CXR/EtCO2 confirmation documented Debrief completed

Pearls

Post-intubation harm often comes from missed sedation, inappropriate ventilator settings, hemodynamic collapse, or poor handoff.
Say aloud: Tube is confirmed. Sedation and analgesia are active. Vent settings are reviewed. Blood pressure is reassessed. Tube depth is documented. Let’s debrief the case.

Pitfalls

Forgetting analgesia/sedation after paralysis
Leaving FiO2/PEEP/RR unchanged without reassessment
Ignoring post-intubation hypotension
No debrief after difficult attempt