During transport, an intubated post-cardiac arrest patient starts to cough against ventilations. Tidal volume decreases and vital signs show P 91 with EtCO2 43 mmHg. What should you do?

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When an intubated patient on ventilation starts coughing, the immediate issue is airway reflex activity that disrupts ventilation. Sedation to suppress the cough is the most effective way to restore ventilator synchrony and deliver the intended tidal volume. Midazolam provides rapid, reliable sedation and quiets airway reflexes without addressing a cause that isn’t present, allowing the ventilator to work as intended. Increasing tidal volume at this moment could risk lung injury or worsen dynamic hyperinflation if the patient remains reflexively coughing. Naloxone would treat opioid-related respiratory depression, which isn’t suggested by the scenario. Chest compressions aren’t indicated because the patient still has a pulse and capnography shows ongoing circulation and ventilation. After sedation, recheck tube position and ventilation parameters and reassess the patient’s comfort and airway.