Chart — Critical Care
Ventilator Alarm Troubleshooting Chart
High pressure, low pressure, apnea, volume, and FiO₂ alarms — causes, check-first priorities, and clinical actions for ICU nurses.
Educational use only. Ventilator changes are made per provider orders and respiratory therapy protocols; escalate alarms you cannot resolve immediately. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Always assess the patient first — then troubleshoot the machine.
If cause is not immediately clear and patient is deteriorating: disconnect → BVM → call for help.
DOPE — Acute Deterioration
Displacement
ETT moved — assess depth, sounds, capnography
Obstruction
Secretions / kink / bronchospasm — suction + inspect
Pneumothorax
Absent sounds + instability — emergent decompression
Equipment
Circuit failure — switch to BVM immediately
High Peak Inspiratory Pressure Alarm
Triggers when airway pressure exceeds set upper limit. Indicates increased airway resistance or decreased lung compliance.
| Cause | Check First | Clinical Action |
|---|---|---|
| Secretions / mucus plug | Suction ETT immediately | Clear secretions; reassess breath sounds; SpO₂ monitoring |
| Patient biting tube | Observe patient; look for jaw clenching | Insert bite block; reassess sedation level |
| Patient coughing | Assess triggering and synchrony | Optimize sedation/analgesia; reassess ventilator triggering |
| Bronchospasm | Auscultate for diffuse wheeze | Administer bronchodilator as ordered; notify provider |
| Circuit kink | Inspect full circuit from machine to ETT | Straighten tubing; ensure circuit is properly supported |
| Right mainstem intubation | Auscultate bilaterally (absent left sounds) | Notify provider; pull ETT back to correct position; obtain CXR |
| Pneumothorax | Absent unilateral breath sounds + hemodynamic instability | EMERGENT — notify provider; prepare for needle decompression |
| Worsening ARDS / ↓ compliance | Bilateral changes; gradual pressure increase over time | Notify provider; may need plateau pressure assessment and vent adjustment |
Low Pressure / Low Exhaled Volume Alarm
Indicates a leak or break in the ventilator circuit — the breath is not reaching or staying in the patient.
| Cause | Check First | Clinical Action |
|---|---|---|
| Circuit disconnection (most common) | Look and listen — visible disconnect; audible hissing | Reconnect immediately; assess chest rise; verify bilateral breath sounds |
| ETT cuff leak | Audible leak around ETT; low exhaled volume; gurgling | Check cuff pressure (target 20–30 cmH₂O); reinflate; notify provider if ruptured |
| Loose tubing connector | Trace full circuit — find loose fitting | Reconnect fitting; verify all connections are secure |
| Partial extubation | ETT depth at lips is higher than documented baseline | Secure ETT; do not push back — notify provider; prepare for reintubation |
Apnea Alarm
Triggers when no breath is detected within the set apnea interval. Vent switches to backup apnea ventilation mode.
| Cause | Check First | Clinical Action |
|---|---|---|
| Over-sedation | RASS score — deeply sedated? | Hold sedation per protocol; stimulate patient; notify provider |
| Opioid-induced respiratory depression | Recent opioid administration? Rate and depth of breathing? | Reduce opioid; naloxone if ordered; monitor closely; notify provider |
| Neurological event | Pupillary changes, facial asymmetry, new motor deficit | Full neuro assessment; notify provider immediately; emergent imaging if new deficit |
| Insufficient trigger sensitivity | Patient breathing effort present but not triggering vent | Notify RT to reassess trigger sensitivity; patient may be breathing spontaneously but effort not detected |
Patient-Ventilator Dyssynchrony Types
| Type | What's Happening | Signs | Action |
|---|---|---|---|
| Trigger Dyssynchrony | Patient effort not triggering vent breath | Visible breathing effort without vent cycling; labored breathing | Notify RT — reassess trigger sensitivity; check for auto-PEEP |
| Flow Dyssynchrony | Set flow rate less than patient demand | Scooped pressure waveform; active patient effort mid-breath | Optimize analgesia/sedation; notify RT for flow rate adjustment |
| Cycle Dyssynchrony | Vent inspiration ends before/after patient effort ends | Double triggering; active exhalation before vent cycles | Notify RT to adjust inspiratory time or cycling threshold |
| Auto-PEEP (Breath Stacking) | Incomplete exhalation before next breath — air trapping | Elevated baseline PEEP; hypotension (↑intrathoracic pressure) | Allow more expiratory time; notify provider; may need rate reduction or bronchodilator |
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Society of Critical Care Medicine (SCCM) · Surviving Sepsis Campaign · American Association of Critical-Care Nurses (AACN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →