Responding to Problems in the Ventilated Patient
Two common problems require systematic assessment: hypoxaemia and hypercapnia. The DOPE mnemonic is a useful starting point when a ventilated patient suddenly deteriorates — Displacement of the ETT, Obstruction (secretions, kinking), Pneumothorax, Equipment failure. These four causes between them account for the vast majority of acute deteriorations in ventilated patients and each can be rapidly assessed and treated at the bedside.
| Problem | Immediate Assessment | Treatment Options |
| Hypoxaemia (SpO2 falls) | Listen to chest (equal air entry?); check ETT position; examine CXR; ABG | Increase FiO2; increase PEEP; recruitment manoeuvre; treat underlying cause (pneumothorax, plugging, position change) |
| Hypercapnia (CO2 rises) | Check VT × rate = adequate minute ventilation; is patient fighting the ventilator? | Increase respiratory rate; increase VT (if safe); lighten sedation if self-breathing; treat bronchospasm |
| High airway pressures | Check for tube obstruction, secretions, pneumothorax, bronchospasm, breath stacking | Suction ETT; reduce VT; check I:E ratio; bronchodilators; exclude pneumothorax urgently |
| Patient-ventilator dyssynchrony | Assess patient effort, comfort, and ventilator trigger sensitivity | Optimise analgesia and sedation; adjust trigger sensitivity; consider mode change; senior review |