Postintubation

Postintubation refers to the period following endotracheal intubation, encompassing the immediate airway management and ongoing stabilization in the intensive care unit, emergency department, or operating room. The goals are to secure the airway, ensure adequate ventilation and oxygenation, and prevent complications during the transition to longer-term ventilation or weaning.

Key steps include confirming tube placement with end-tidal CO2, careful auscultation, and waveform capnography, with radiographic confirmation as needed. The endotracheal tube must be securely fixed to prevent accidental dislodgement, and staff should routinely check tube position and depth. Secretions should be cleared with suctioning, and humidified oxygen provided to support airway patency.

Monitoring and ventilation are guided by oxygenation and ventilation targets. Continuous pulse oximetry, frequent blood gas analysis, airway pressures, and capnography help assess function and detect complications. Cuff pressure should be monitored and maintained within a safe range to reduce tracheal injury.

Common postintubation complications include airway trauma and edema, vocal cord injury, post-intubation stridor, accidental extubation, obstruction from secretions, aspiration, and an increased risk of ventilator-associated pneumonia. Hemodynamic instability and delirium can complicate recovery and require multidisciplinary management.

Weaning and extubation are planned with readiness assessment, often using a spontaneous breathing trial to test the patient’s ability to breathe without full support. If extubation is successful, supplemental oxygen is provided as needed and the patient is closely observed for signs of respiratory failure.

Prevention focuses on minimizing airway trauma and ventilator-associated complications through careful technique, appropriate sedation to reduce agitation, and regular cuff pressure monitoring (aiming for 20–30 cm H2O). Oral care, humidification, early mobilization, and infection prevention contribute to better outcomes.