What should be done if continuous expired ETCO2 cannot be detected?

• A. Increase the tidal volume.
• B. Administer bronchodilators.
• C. Place the patient in Trendelenburg position.
• D. Remove the invasive airway device and manage the airway non-invasively.

Answer: (D)

When continuous expired ETCO2 cannot be detected, the main issue is that there is no reliable signal of alveolar ventilation. This typically points to a problem with the airway or ventilatory circuit—things like the endotracheal tube becoming dislodged, kinked, blocked, or disconnected, or a major circuit failure. The immediate goal is to ensure the patient is being ventilated and oxygenated while you identify the cause. If you cannot restore effective ventilation through the invasive airway, the safest next step is to remove the invasive airway device and switch to non-invasive airway support (such as bag-valve-mask ventilation with oxygen) to re-establish ventilation and reassess. The other options won’t directly address the absence of a CO2 signal: increasing tidal volume targets ventilation but won’t fix a dislodged or blocked tube; bronchodilators help with airway resistance, not with a non-detectable CO2 signal; Trendelenburg positioning does not resolve ventilation/CO2 issues.