21st February 2025

A 43-year-old woman is intubated on ITU after being admitted with a severe pneumonia.

A 43-year-old woman is intubated on ITU after being admitted with a severe pneumonia. On day 3 of admission, she is noted to become tachycardic with dropping oxygen saturations on her bedside monitor.

On assessment, her heart rate is 120 beats per minute, blood pressure 80/40 mmHg and oxygen saturations 85% on 90% FiO2. Her last set of observations 20 minutes ago showed a heart rate of 85 beats per minute, blood pressure 115/95 and oxygen saturations 92% on 60% FiO2.

On examination, there is reduced movement of the left hemithorax with reduced air entry and hyperresonant percussion notes on the left lung field.

What is the most appropriate immediate management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.