What is the STOPMAID checklist?

STOPMAID is a pre-intubation checklist that stands for Suction, Tools, Oxygen, Position, Monitors, Airway assistant, IV access, and Drugs. It ensures all critical steps are complete before airway management begins.

How do you preoxygenate a patient before intubation?

Effective preoxygenation involves using a non-rebreather mask plus nasal cannula at flush rate or a high-flow nasal cannula. The goal is not just to raise SpO2, but to denitrogenate the lungs and extend safe apnea time.

When should you decide to intubate in the ICU?

If you're thinking about intubating a patient, you probably should. Indications include altered mental status, hypoxemia, hypercapnia, hemodynamic instability, or predicted clinical deterioration.

What should you do after the patient is intubated?

Stay in the room for at least 5–10 minutes to monitor for post-intubation hypotension or hypoxia. Order a chest X-ray, ABG, and confirm ventilator settings and sedation strategy.

Can non-airway credentialed providers help with intubation?

Yes, non-airway managers can prepare the room, start preoxygenation, communicate with the team, and set up medications and tools—greatly improving patient safety and efficiency.

[PCL] Owning the Airway (when you don't own the airway)

PCL

Mar 5

Written By Rachel F

Pulmcast Little podcast cover featuring intubation setup tips for APPs in the ICU — How do you set up the room for a patient to be intubated if you *aren't* credentialed for airway management? What do you do while you're waiting for someone to come in and tube the patient?

In this Pulmcast Little, we walk through how to safely and efficiently set up for intubation—even if you're not the one performing it. Designed especially for advanced practice providers (APPs), this quick-hit episode covers how to assess when it's time to intubate, how to prepare the room and team, how to preoxygenate effectively, and what steps to take post-intubation. Plus, we introduce the STOPMAID checklist to ensure you're ready for anything. Whether you're new to critical care or just want a high-yield refresh, this episode has what you need to move like a well-oiled ICU machine.

How to Set Up for Intubation (Even if You're Not Doing the Tubing)

Welcome to something a little different: our first ever Pulmcast Little. These mini-episodes deliver high-yield ICU pearls in under 15 minutes. First up: what to do when your patient needs to be intubated—and you're not the one managing the airway.

Step 1: Deciding to Intubate

If you're wondering whether to intubate, you probably should. As Marino says, "A patient should be intubated when you're thinking about intubating them."

Early intubation avoids the deterioration that comes with delay. Don’t waffle. General indications include:

Altered mental status
Severe hypoxemia or hypercapnia
Hemodynamic instability or need for multiple pressors
Expected clinical deterioration

Trust your clinical gut and move early when possible.

Step 2: Prepare the Room

Once the decision is made, recruit your team:

Respiratory Therapist: set up suction, laryngoscope, and video scope
Nurse: prepare fluids, pressors, and optimize IV access

Then, begin preoxygenation right away. This is critical. The goal isn’t just to make the SpO2 100%, but to denitrogenate the lungs to buy safe apnea time.

Best options:

Non-rebreather + nasal cannula at flush rate
High-flow nasal cannula
BiPAP (especially if already on it)

Why both NRB and NC? Because most masks don’t seal perfectly, and tachypneic patients entrain room air, reducing oxygen delivery. Combine devices to get closer to 100% FiO2 and maximize safe apnea time.

Step 3: Create a Shared Mental Model

Before the intubator arrives, brief the room:

Is this emergent or controlled?
What are the anticipated complications (e.g. hypotension, PH)?
What are your backup plans?

Being explicit about expectations allows the whole team to respond quickly if things go sideways.

Step 4: Call the Airway Manager

If you're not intubating, now’s the time to call anesthesia, the attending, or emergency physician. Be clear:

"I'm calling you for an emergent intubation for hypercapnic respiratory failure. Room is set up. Do you have a medication preference?"

Also check the potassium level to guide med choice (e.g., succinylcholine).

Diagram comparing non-rebreather, nasal cannula, and BiPAP use for preoxygenation — *The sniffing position*

Step 5: Run Through STOPMAID

Use a mental or written checklist to make sure nothing is missed:

S – Suction (ready and working)
T – Tools (laryngoscope, tube, bougie, scalpel, LMA, OPAs, NPAs)
O – Oxygen (preoxygenation complete)
P – Position (sniffing position, HOB up)
M – Monitors (cycling BP q2min, SpO2 on opposite arm)
A – Airway assistant (roles defined)
I – IV access (secured)
D – Drugs (induction + paralytics drawn and labeled)

Step 6: Demand a Plan

Ask the airway provider to verbalize:

Plan A (first attempt)
Plan B (backup)
Plan C (surgical airway or LMA)

As Scott Weingart says: "There is no such thing as an emergent intubation—only emergent oxygenation followed by a slow, controlled intubation."

Step 7: Stay in the Room Post-Intubation

This might be the most dangerous time. Stick around to monitor:

Hypotension (start/adjust pressors)
Hypoxia (check for right mainstem, pneumothorax, or esophageal placement)
Vent settings with RT

Order your chest X-ray and ABG, discuss sedation strategy, and don’t leave just because the tube is in.

Final Thoughts

Whether you're a brand-new APP or a seasoned clinician, knowing how to manage the room around intubation—even if you're not holding the laryngoscope—can dramatically improve outcomes.

Move early
Set up with intention
Run STOPMAID
Plan like a pro
Stay present after the tube goes in

Visual breakdown of the STOPMAID mnemonic for airway setup in critical care

Attributions

Longing by Joakim Karud https://soundcloud.com/joakimkarud
Music promoted by Audio Library https://youtu.be/wSL0sGLTgLQ

PCL2018intubation checklistPulmcast Littleanesthesia preparationpatient safety ICUpulmonary educationnon-intubator protocolnurse intubation prepairway setup guideemergency intubation stepsPulmcastcritical care podcastpreoxygenation methodsAPP ICU trainingicu airway prepSTOPMAID

Rachel F

Rachel is a physician assistant who has been holding down the ICU since 2016. She joined the Pulmcast podcast in 2017 and has been hooked on FOAMed ever since. Rachel has a passion for teaching using technology with a special focus on preserving dignity in the ICU. When she's not at work, you’ll find her playing with her golden retriever, hunting for thrift store treasures, and soaking up time with her husband and son.

[PCL] Owning the Airway (when you don't own the airway)

How do you set up the room for a patient to be intubated if you aren't credentialed for airway management? What do you do while you're waiting for someone to come in and tube the patient?