Peter Antevy explains why intubating asthma and COPD patients is dangerous without careful preparation. Early intubation risks barotrauma, pneumothorax, and cardiac collapse. Exhaust medical therapy first, then use slow inspiratory times and long expiratory times on the ventilator to avoid killing the patient.
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So we're going to talk about intubating a respiratory distress patient, respiratory failure. We're going to focus mainly on the asthma patient. I implore you, really implore you to use intubation as the last ditch effort. Intubating an asthma patient is deadly. More patient will die from being intubated.
Because of the complication of what we talked about with Baro thorax, right, where we talked about the cpap, right? With the air, you know, as the air is pushed in, forced in, the air can come out slowly and the thorax increase, increase, increase. Then it causes barothorax, pneumothorax, decreased return hypoxemia.
Hypotension and cardiac failure. So I'm not saying do not intubate. I'm just saying don't intubate too early. Give time for your protocol to work, Give your medication. Intubating a patient with COPD is the same. We need to think of both. Inspiration phase, the air going in from the machine to the patient expiration phase, the time it takes the air to go out of the patient back to the machine, right. We want a slow inspiration time, right? Air in fast and we want a long expiration time, right. Remember when we talked about in cpap, we talked about if the patient blood pressure starts dropping.
They have retention. You want to disconnect the patient, press on their chest and allow all for that gas to be pushed out again. Use caution in intubating patient, patient with asthma. If you're taking neuromuscular blockade, if you use succinylcholine, rocuronium, what are you doing? You're blocking the patient effort, own effort. And now you have no more visual cue to see what's going on. And so it is really easy if you're not paying attention to the alarms on the ventilators, especially your positive inspiratory pressure pip. If your alarm goes up and up and up, that means you're inflating the lung. Inflating the lung, inflating the lung until they pops.
