Endotracheal Intubation and Medication Management: Evidence-Based Nursing Interventions for Airway Stabilization and Sedation
Abstract
Background: Endotracheal intubation is a critical intervention in emergency and critical care settings, requiring rapid airway control to prevent hypoxemia, aspiration, and cardiovascular collapse. Nurses play a pivotal role in preparation, medication management, and post-intubation care.
Aim: This study aims to review evidence-based nursing interventions for airway stabilization and sedation during rapid sequence intubation (RSI), focusing on pharmacologic mechanisms, procedural safety, and team-based strategies.
Methods: A comprehensive literature review was conducted, synthesizing current guidelines and clinical evidence on RSI, including indications, drug selection, endotracheal tube (ETT) characteristics, and the “7 Ps” framework for safe administration.
Results: RSI is the standard of care for emergent airway management when difficulty is not anticipated. Induction agents such as etomidate, ketamine, and propofol provide rapid sedation, while neuromuscular blockers like succinylcholine and rocuronium ensure paralysis. Each drug has unique hemodynamic and neurologic profiles, influencing selection based on patient physiology. Nursing responsibilities include preoxygenation, equipment readiness, accurate dosing, monitoring for adverse effects, and initiating post-intubation sedation. Common complications include aspiration, esophageal intubation, hypotension, and medication-specific risks such as adrenal suppression (etomidate), emergence reactions (ketamine), and hypotension (propofol).
Conclusion: RSI success depends on meticulous preparation, pharmacologic literacy, and interprofessional collaboration. Nurses are integral to preventing complications and ensuring safe transitions to mechanical ventilation.
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Authors
Copyright (c) 2025 Salmah Abdullah Hamdi, Hanan Muawwadh Abdulaziz Alodayni, Sharefh Hassan Ali Hazaze, Norah Marzouq Saad Alabdullah, Eman Ahmed Musaad Alazmi, Sharefa Salem Faraj Alotaibi, Bashayer Hassan Mohammed AlMashe, Norah Saad Ibrahim AlMunyif, Merfat Husni Ali Albaltaji, Muneerh Mansor Albishi, Shaimaa Ali Abdullah Jathami, Kholoud Meshabbab Mansour Al-Bishi
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