Intubation forms a cornerstone of advanced airway management, giving patients oxygen in emergency situations and the surgical suite, in addition to providing long-term breathing support for critically ill patients. Patients will need both immediate and longer-term support following intubation, regardless of the reason for the procedure. Monitoring patients during intubation and providing appropriate follow-up care and support can improve outcomes as well as quality of life.
Short-Term Post-Intubation Care
Intubation is the beginning (not the end) of advanced airway management. Particularly in an emergency, the temptation is to believe that if the emergency has passed, then successful intubation has been achieved. Do not make this mistake. Instead, focus on these key post-intubation steps:
- Hook up waveform capnography to monitor the patient.
- Ensure that the tube is stable and well secured.
- Give the patient’s family updates on the patient’s progress, especially if there was little time for information during the emergency.
- Humidify the air if appropriate.
- Place in-line suction.
- Provide analgesia and sedation if appropriate.
- Watch for signs of aspiration past the endotracheal tube (ETT) cuff.
- Assess vital signs and continue any necessary critical care or resuscitation.
- Provide vasopressors if the patient is in a hypotensive state, especially when giving sedation or analgesia.
- Elevate the patient’s head to an angle of approximately 45 degrees.
- Set initial ventilator settings.
Communication between care providers is critical here, especially if you are transporting the patient to the ICU or the emergency department. Note the patient’s vital sign history, the reason for the intubation, any relevant medical history, and any important status changes. It’s also important to educate the family or caregivers about the patient’s status. They’ll be the ones advocating for the patient after your job is done, so they need as much information as you can offer.
Long-Term Post-Intubation Care
Intubation can be a traumatic experience, especially in an emergency. Patients may need psychological support. Early emotional support may even prevent complications such as post-traumatic stress disorder (PTSD) and boost compliance with long-term treatment goals. Where appropriate, refer patients to social workers or psychological support. Patients who are intubated for extended periods may also need swallowing or speech therapy. Warning them of this fact can reduce anxiety and help them access the right support. Be prepared to offer a referral to an appropriate speech therapist.
When a patient has a chronic underlying medical condition, it’s important to help them understand what ideal care looks like. Many patients mistakenly believe that if the initial crisis passes, then no additional care is necessary. Make appropriate referrals to specialists and talk to the patient about care options so that you can help them identify both medical and lifestyle changes that may improve their prognosis, especially if the diagnosis is new.
Why Equipment Matters
The right equipment is key no matter the reason a patient is intubated. It reduces the risk of complications, makes the process easier for the patient and care provider, and can even save lives in emergencies. Portable emergency suction isn’t just for first responders. It also allows hospitals and clinics to provide care to patients wherever they are, thereby meeting their emergency care obligations under the Emergency Medical Treatment and Active Labor Act (EMTALA). Historically, portable suction machines have been less reliable, or have had very short battery lives. Today’s portable suction machines offer consistent, reliable suction and long battery charges. For help selecting the right machine for your patients’ needs, download our free guide, The Ultimate Guide to Purchasing a Portable Emergency Suction Device.