Medical

Salicylate toxicity / toxicologic hyperventilation

Before / During / After / Pitfalls

Before

• This is a dangerous airway: spontaneous hyperventilation may be life-preserving and difficult to match after paralysis.
• Treat toxin physiology first when possible: decontamination/alkalinization/renal replacement pathway per local toxicology protocol.
• Plan minimal apnea, immediate ventilation after tube, and early tox/ICU/nephrology support.

During

• Avoid prolonged apnea and avoid hypoventilation after confirmation.
• Use EtCO₂ as a trend only; follow rapid blood gas and pH.
• Have bicarbonate/vasopressor/resuscitation pathway ready per protocol.

After

• Set ventilation deliberately to avoid abrupt CO₂ rise and worsening acidemia.
• Continue alkalinization/elimination strategy; the airway is supportive, not definitive therapy.
• Frequent pH, potassium, glucose, temperature, and neurologic reassessment.

Pitfalls

• Routine RSI with prolonged apnea.
• Post-intubation RR/ventilation far below pre-intubation demand.
• Focusing on the tube while delayed toxin therapy continues.