What you should know about starting and stopping intubation and a ventilator

With COVID-19 and coronavirus saturating the news, there’s been more attention than ever on ventilators and intubation.

What does it mean to be intubated?

Intubation, or being intubated, occurs when a doctor or other provider inserts a flexible tube down a patient’s throat to secure an open, or patent and protected, airway.

Anesthesiologists, critical care physicians, pulmonologists, and emergency (ER) doctors are all physicians who frequently are called on to intubate patients. They are usually skilled and well-practiced in intubating patients quickly, but intubation doesn’t come without risks.

Sometimes intubation is done as part of the anesthetic care provided for a long surgery. In those situations, the standard of care requires an anesthesiologist to perform a pre-anesthesia assessment, which includes evaluating the patient’s airway. When patients are obese, overweight, or have sleep apnea, for example, there’s a higher risk of respiratory complications and that the patient will have a difficult airway. This means that the anesthesia team is required to make special preparations during the surgery. The last thing anyone wants is to be frantically scurrying about in an emergency!

In many other situations, physicians intubate patients who are having difficulty breathing or ventilating properly. This can happen in an emergency room or for hospitalized patients.

One of most common mistakes that doctors and providers make in attempting intubation is inserting the endotracheal tube into the esophagus (the food tube, a muscular structure that’s part of the digestive system), rather than the trachea (the air tube, or windpipe). This can cause serious injuries to patients.

How does the ventilator come into play?

Once a patient is properly and safely intubated, the exposed end of the endotracheal tube can be connected to the ventilator. The ventilator is a medical device that assists patients with breathing and respiration. The ventilator mechanically pushes air into the lungs for inspiration and also helps remove carbon dioxide for exhalation.

Deciding when to stop the ventilator and extubate

The decision to intubate the patient and start a ventilator is often made very quickly. Deciding when it’s appropriate to stop the ventilator and remove the breathing tube (extubation) can be a bit more challenging.

At Painter Law Firm, we’ve handled various malpractice cases where children and adults were prematurely extubated and went into respiratory arrest that led to brain injury or death.

Situations like that are why the standard of care requires a careful medical evaluation to determine whether it’s safe to terminate a patient’s ventilator and perform extubation. The medical literature and standard of care reflect that extubation is improper if the patient:

• Is in acute respiratory failure and needs active management. Before extubating the patient, it’s important to identify and treat the cause of respiratory failure.

• Is unable to maintain proper oxygenation (generally considered an oxygen saturation of 90% or higher by pulse oximetry) with low-level respiratory support.

• Can’t maintain an open airway. This means that the patient must have minimal secretions that can be cleared by a strong cough. With more copious secretions, nurses, respiratory therapists, or doctors may have to suction the secretions out of the airway to allow airflow.

• Has cardiovascular instability.

• Isn’t conscious. Most doctors require a Glasgow Coma Scale (GCS) score of 8 or greater. For most patients, doctors expect a mental status where the patient is alert, awake, and able to follow commands.

• Has an acute brain injury that necessitates intubation.

Rushing the extubation decision is not in the interest of patient safety. If you’ve been seriously injured because of this type of error and poor care, then contact a top-rated skilled Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter
Article by

Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.