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Troubleshooting review

Hypoxia: stacking / auto-PEEP

Air trapping can worsen oxygenation and cause hypotension.

Educational review boundary: This page summarizes common patterns and published management options. It does not analyze an individual patient or generate a treatment directive. Verify the current source, local protocol, and clinical context.
See auto-PEEP waveformFlow not returning to baseline.Ventilator timing referenceEstimate expiratory time.If MAP fallsAuto-PEEP shock.

Act

  • Bag slowly; allow full exhalation.
  • Lower RR and shorten inspiratory time/increase inspiratory flow as appropriate.
  • Treat bronchospasm and dyssynchrony.
  • Consider brief disconnect if crashing and air trapping is suspected.

Clinical review / use limits

Authored by: Airway of the Month education team. Last reviewed: July 2026. Audience: EM learners, faculty, EMS, RT, simulation educators, and airway teams.

Resources · Editorial policy · ACEP intubation policy · AARC 2024 ventilator assessment guideline · ATS 2024 ARDS guideline update

About this resource
Created by: Andrew Pirotte, MD; Kyle Brown, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: Emergency medicine faculty review completed. Medication content reviewed by Amanda Vanderwerf, PharmD, BCEMP, and Morgan Kimball, PharmD, BCEMP. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and clinical-reference guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: [email protected]