{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T23:41:01Z","timestamp":1780443661399,"version":"3.54.1"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,2,23]],"date-time":"2025-02-23T00:00:00Z","timestamp":1740268800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Methods<\/jats:title><jats:p>Few guidelines address how to handle unanticipated ventilatory problems and hypoxemia in a successfully intubated patient. We will refer to this situation as \u201ccan intubate\u2013cannot ventilate.\u201d The situation may occur immediately after intubation or later during general anaesthesia. The aim of this paper is to describe an algorithm for handling this situation. In an intubated patient, the airway can be considered a continuum from the ventilator to the alveoli, and the problem is somewhere along this route: Ventilator \u2192 Hoses \u2192 Filter \u2192 Tracheal tube (TT)\u2009\u2192\u2009Tracheae \u2192 Bronchi \u2192 Bronchioles \u2192 Alveoli. The proposed algorithm is based on clinical experience and has not been externally validated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The first critical decision to be made is whether the TT has been placed correctly in the trachea or not. Positive wave\u2010formed capnography is the primary marker for correct intubation. Video and\/or direct laryngoscopy can be used for further verification. The patient should be disconnected from the ventilator and manually ventilated with bag\u2010valve and 100% oxygen. An open tube should then be verified by applying a suction catheter through the tube. If these measures do not improve the situation, a fibreoptic scope should be inserted to further assess possible causes of difficult ventilation. If no obvious treatable cause is detected at this point, bronchospasm, anaphylaxis, or pneumothorax should be ruled out or treated. Further handling should focus on optimizing gas exchange in the lungs and considering more advanced treatment options to improve oxygenation and circulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We have proposed an algorithm to handle unanticipated problems with ventilation and oxygenation in a patient who has been successfully intubated. Equipment failure and a blocked TT should be ruled out before diagnosing and treating medical or surgical causes of ventilatory problems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Editorial Comment<\/jats:title><jats:p>This article presents a logical approach to the time\u2010sensitive and critical situation where, for some reason, after intubation, ventilation of the lungs is not succeeding. The authors propose steps for a systematic approach, and recognition of different possible explanations for ventilation not working is informative.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.70007","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T08:13:26Z","timestamp":1740557606000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Can intubate, cannot ventilate: A proposed algorithm to handle problems with ventilation and oxygenation after intubation"],"prefix":"10.1111","volume":"69","author":[{"given":"Kjetil","family":"Fosse","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine St. Olav Hospital  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Salomonsen","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine St. Olav Hospital  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven Erik","family":"Gisvold","sequence":"additional","affiliation":[{"name":"Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences Norwegian University of Science and Technology (NTNU)  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rnar","family":"Gundersen","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine St. Olav Hospital  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trond","family":"Nordseth","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine St. Olav Hospital  Trondheim Norway"},{"name":"Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences Norwegian University of Science and Technology (NTNU)  Trondheim Norway"},{"name":"Department of Research and Development, Division of Emergencies and Critical Care Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev371"},{"key":"e_1_2_10_3_1","unstructured":"WHO Team Integrated Health Services.WHO guidelines for safe surgery: safe surgery saves lives.2009. 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