Reference — Critical Care
Ventilator Alarm Reference
Quick bedside reference for ventilator alarm types, common causes, and immediate nursing actions — assess the patient first, then troubleshoot the machine.
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.
Safety Rule — Always Assess the Patient First
When any ventilator alarm sounds: look at chest rise, SpO₂, skin color, and patient responsiveness before troubleshooting. If cause is not immediately identified and patient is deteriorating, disconnect from ventilator and manually ventilate with BVM while calling for help.
DOPE — Acute Ventilated Patient Deterioration
Displacement
ETT moved — right mainstem or accidental extubation. Auscultate bilaterally, verify depth at lips, check capnography.
Obstruction
Secretions, tube kink, or bronchospasm blocking airflow. Suction first; inspect circuit; administer bronchodilator if ordered.
Pneumothorax
Absent unilateral breath sounds + hypotension + hypoxia. EMERGENT — notify provider for needle decompression.
Equipment Failure
Circuit disconnection, power failure, machine malfunction. Switch to BVM immediately; call RT/provider.
Alarm Reference Table
| Alarm | What It Means | Common Causes | Immediate Nursing Action |
|---|---|---|---|
| High Peak Inspiratory Pressure | Airway pressure exceeded upper limit | Secretions (most common), biting/coughing, bronchospasm, kink, right mainstem, pneumothorax | Assess patient → suction → inspect circuit → auscultate bilaterally → notify provider if unresolved |
| High Plateau Pressure | Decreased lung compliance | ARDS progression, pneumothorax, auto-PEEP, pulmonary edema | Differentiate from high PIP (plateau = compliance issue). Notify provider; reassess vent settings |
| Low Inspiratory Pressure / Low Exhaled Volume | Circuit leak or disconnection | Disconnection (most common), cuff leak, loose tubing connector | Assess chest rise → trace full circuit → reinflate ETT cuff → reconnect if disconnected → assess patient |
| Apnea Alarm | No breath detected within apnea interval | Over-sedation, opioid depression, neurological event | Assess responsiveness and breathing effort → check sedation → notify provider → vent switches to backup mode |
| Low Respiratory Rate | Patient rate below minimum | Over-sedation, neurological event, patient-vent sync issue | Assess sedation (RASS) → assess spontaneous effort → notify provider |
| High Respiratory Rate | Patient triggering above set maximum | Pain, anxiety, hypoxia, CO₂ retention, fever, dyssynchrony | Assess patient comfort, SpO₂, pain level → address cause → notify provider for potential vent adjustment |
| FiO₂ Alarm | Delivered O₂ concentration is outside set range | O₂ source failure, blender malfunction, circuit leak | Check O₂ supply pressure → assess SpO₂ → notify RT if persists |
| Low PEEP | End-expiratory pressure below set value | Large circuit leak, cuff deflation, patient exhaling forcefully | Check cuff pressure → inspect circuit → notify RT/provider |
Key Pearls
- ›High PIP with bilateral breath sounds = secretions or bronchospasm. Suction first.
- ›High PIP with absent unilateral breath sounds = pneumothorax or right mainstem. Emergent assessment.
- ›Low pressure with no chest rise = disconnection. Reconnect and assess immediately.
- ›Apnea alarm = over-sedation until proven otherwise. Check RASS and breathing effort.
- ›Auto-PEEP risk: high RR + obstructive disease = breath stacking → hypotension from ↑intrathoracic pressure.
- ›Never silence a vent alarm without first assessing the patient.
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 →