Increased airway pressure
Using these steps from start to end should identify any cause of increased airway pressure in theatre. Avoid spending excessive time and attention on one aspect until you have run through the whole guideline.
If problem worsens significantly or a new problem arises, call for help and go back to START of 1-1 Key basic plan.
Remember that airway "feel" depends on your APL valve setting. You can only "feel" a maximum of what the APL valve is set to. Measured expired tidal volume gives additional information.
Ventilate lungs using self-inflating bag connected DIRECTLY to tracheal tube connector.
DO NOT use HME filter, angle piece or catheter mount.
If increased pressure manually confirmed, re-connect machine.
If problem resolved, assume problem with machine, circuit, HME, filter, angle piece or catheter mount: check and replace.
Inadequate neuromuscular blockade.
If laparoscopic surgery, consider releasing pneumoperitoneum and levelling patient position.
Consider potential causes:
Laryngospasm and stridor → 3-6
Bronchospasm → 3-4
Anaphylaxis → 3-1
Circulatory embolus → 3-5
Aspiration, pulmonary oedema; bronchial intubation; foreign body; pneumothorax.
Consider potential actions: tracheal/bronchial suction; bronchodilator; PEEP; diuretic; bronchoscopy.