Post-intubation

Post-intubation hypotension

Before / During / After / Pitfalls

Before

• Before meds, identify shock/acidosis/RV failure/volume depletion and prepare pressors/resuscitation.
• Choose induction/sedation strategy with hypotension risk in mind.
• Have a named post-tube BP reassessment owner.

During

• If hypotension occurs: check tube/oxygenation, reduce excessive intrathoracic pressure, assess sedation effect, volume/bleeding/RV/auto-PEEP.
• Treat reversible causes quickly; use pressor/resuscitation pathway per protocol.
• Do not ignore falling EtCO₂/MAP after tube.

After

• Reassess sedation/analgesia, ventilator pressures/PEEP, volume status, bleeding/sepsis/PE/RV failure.
• Trend MAP, EtCO₂, lactate/perfusion and adjust plan.
• Debrief if airway sequence precipitated collapse.

Pitfalls

• Calling it “just sedation” without checking auto-PEEP/RV/bleeding/tension.
• High PEEP in preload-dependent patient.
• No pressor plan before paralysis.