Act
- Bag slowly; allow full exhalation.
- Lower RR and shorten inspiratory time/increase inspiratory flow as appropriate.
- Treat bronchospasm and dyssynchrony.
- Consider brief disconnect if crashing and air trapping is suspected.
Rescue pathway
Hypoxia: stacking / auto-PEEP
Air trapping can worsen oxygenation and cause hypotension.
See auto-PEEP waveformFlow not returning to baseline.I:E calculatorEstimate expiratory time.If MAP fallsAuto-PEEP shock.
Clinical review / use limits
Authored by: Airway of the Month education team. Last reviewed: July 2026. Audience: EM learners, faculty, EMS, RT, simulation educators, and airway teams.
This is an educational cognitive-aid scaffold, not a bedside order set. Verify medications, ventilator changes, pediatric dosing, and procedures against local ED, ICU, anesthesia, pharmacy, RT, EMS, and pediatric policies.
Resources · Editorial policy · ACEP intubation policy · ARDS ventilation reference