What are mechanical ventilators? Part 1: when should someone be intubated?

Let’s say you’re in the MICU, and you get a report that a 60-year old male found down is rolling up to your floor in the next 30 minutes. “He’s intubated,” the emergency resident reports. Without even asking, for what reasons might this guy be intubated?

Or, you’re on the floor and have a patient admitted for aspiration pneumonia who has become more “sleepy” over the course of the day. The nurse has stopped you multiple times in the hall to ask you how you think the patient is doing, what the plan is, and as she walks away, you hear her sign, “Well, he’s heading towards intubation…”

So how do you know that someone might need to be intubated?

There are three basic reasons to remember:

  1. severely altered mental status or inability to protect airway
  2. hypoxic respiratory failure
  3. hypercapnic respiratory failure

Everything else, ranging from aspiration pneumonitis to anaphylaxis to drug overdose to diffuse alveolar hemorrhage, comes from one of these three reasons.




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