Post Intubation Hypoxia

If the patient suddenly develops post intubation hypoxia use the acronym ‘DOPES’ to help troubleshoot the problem.

D: Dislodgement of the tube – check depth of tube against recorded depth at intubation. Is ETCO2 still connected and recording?

O: Obstruction – can a suction catheter be passed?

P: Pneumothorax – consider clinical examination, Point of Care Ultrasound (POCUS) or portable Chest X-ray

E: Equipment failure – disconnect ventilator and return to manual BVM.

S: Stacked breaths – especially auto-PEEP in COPD/asthma. Disconnect from ventilator. If reconnecting to ventilator consider decreasing RR, decreasing I:E ratio (to increase expiratory time) and ensure optimal sedation.