Tachycardia, tachypnea
Change in BP
Dyspnea
Noisy or shallow ventilation
Rhonchi
Obvious visible secretions
Excessive coughing during inspiratory cycle of ventilator
High-pressure alarm on vent
Low SaO2
• Instillation of saline/saline lavage is ineffective and potentially harmful.
• Subglottic suctioning every 8 hours.
Gastric Residuals
• Checked every 4 hours.
Positioning
• Turning every 2 hours.
• Kinetic therapy to promote redistribution of ventilation and perfusion and optimize 
matching.
Indicated for ALI, ARDS, pneumonia
• Prone position
Consider in ALI, ARDS
Richmond Agitation and Sedation Scale (RASS)
• Sedation is important in ventilated patients. Too little sedation can result in patient’s discomfort, self extubation, removal of other lines and drains, or poor patient-ventilator synchrony. Too much sedation can also be harmful and can delay weaning.
• The RASS is a sedation agitation instrument that was developed to help titrate sedative medication and evaluate agitated behavior in the ICU patients.
• RASS will be completed on all intubated patients every four hours at a minimum. Inadequate sedation or over sedation should be reported promptly to the physician.
• RASS is a 10 point scale that ranges from +4 (combative) to -5 (unarousable). The score should be kept between -1 to -2. The values and definitions are:
+4 Combative
+3 Very agitated
+2 Agitated
+1 Restless
0 Alert & calm
– 1 Drowsy
– 2 Light sedation
– 3 Moderate sedation
– 4 Deep Sedation
– 5 Unarousable
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