After endotracheal intubation, a patient has persistent abdominal distension. What is the most appropriate intervention to relieve it?

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Gastric decompression to relieve air trapped in the stomach is the key concept here. After endotracheal intubation, positive-pressure ventilation often pushes air into the stomach, causing abdominal distension. Placing a nasogastric tube allows direct drainage of that air and any gastric contents, reducing intragastric pressure, improving diaphragmatic excursion, and lowering the risk of regurgitation and aspiration. This approach directly addresses the cause of the distension.

Increasing tidal volume would likely push more air into the stomach, worsening the distension. Diuretics address fluid overload, not gas in the stomach, so they don’t relieve distension. Turning the patient to the left lateral position is not an effective, definitive method for decompressing a distended stomach and won’t reliably relieve the problem.