Post-intubation

Ventilator dyssynchrony / biting tube

Before / During / After / Pitfalls

Before

• Assess pain, anxiety, hypoxia, hypercarbia, bronchospasm, tube depth, and ventilator settings.
• Analgesia/sedation should be adequate before assuming “agitation.”
• Bite block/oral airway if biting threatens ventilation or tube integrity.

During

• Bag manually if unstable and classify resistance, compliance, or synchrony problem.
• Treat the cause: bronchospasm, auto-PEEP, pain, under-sedation, hypoxia, tube position, or settings mismatch.
• Paralysis is a rescue bridge, not a substitute for diagnosis, and requires deep sedation.

After

• Reassess vent waveforms, sedation score, hemodynamics, and analgesia.
• Document boluses/infusions and ongoing plan.
• Involve RT/ICU for persistent dyssynchrony.

Pitfalls

• Only increasing sedatives while missing pneumothorax/auto-PEEP/tube issue.
• Paralyzing without sedation.
• No bite block with tube occlusion risk.