Medical

Severe pneumonia / ARDS physiology

Before / During / After / Pitfalls

Before

• Maximize preoxygenation with NIV/HFNC/BVM-PEEP as appropriate and safe.
• Anticipate rapid desaturation and post-intubation oxygenation failure; call RT/ICU early.
• Prepare ventilator, PEEP/FiO₂ strategy, and rescue oxygenation pathway before meds.

During

• Avoid derecruitment during transition and confirm with waveform EtCO₂.
• Use lung-protective PBW-based tidal-volume concepts after intubation.
• Escalate early if oxygenation remains poor despite basic optimization.

After

• Monitor plateau/driving pressure if available, oxygenation trajectory, hemodynamics, and sedation.
• Consider ARDS/ICU pathway, paralysis/proning/advanced support per local protocol.
• Titrate FiO₂ down when safe.

Pitfalls

• No PEEP during transition.
• Large tidal volumes based on actual weight.
• Late escalation for refractory hypoxemia.