Mechanical ventilation complications: Difference between revisions
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==Overview== | ==Overview== | ||
Complications of mechanical ventilation include, [[oxygen toxicity]], [[ventilator associated pneumonia]] ([[Ventilator-associated pneumonia|VAP]]), [[laryngeal edema]] and [[ulceration]], [[malnutrition]], oversedation/[[delirium]] and ventilator induced lung injury. | |||
==Complications== | ==Complications== | ||
Mechanical ventilation is associated with the following complications: | Mechanical ventilation is associated with the following complications:<ref name="pmid2199002">{{cite journal |vauthors=Pierson DJ |title=Complications associated with mechanical ventilation |journal=Crit Care Clin |volume=6 |issue=3 |pages=711–24 |date=July 1990 |pmid=2199002 |doi= |url=}}</ref><ref name="pmid1776449">{{cite journal |vauthors=Wang GC, Kao HA, Hwang FY, Ho MY, Hsu CH, Hung HY |title=[Complications in the use of mechanical ventilator in newborns: one year's experience] |language=Chinese |journal=Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi |volume=32 |issue=4 |pages=227–32 |date=1991 |pmid=1776449 |doi= |url=}}</ref><ref name="pmid21194139">{{cite journal |vauthors=Principi T, Fraser DD, Morrison GC, Farsi SA, Carrelas JF, Maurice EA, Kornecki A |title=Complications of mechanical ventilation in the pediatric population |journal=Pediatr. Pulmonol. |volume=46 |issue=5 |pages=452–7 |date=May 2011 |pmid=21194139 |doi=10.1002/ppul.21389 |url=}}</ref><ref name="pmid1737455">{{cite journal |vauthors=Rivera R, Tibballs J |title=Complications of endotracheal intubation and mechanical ventilation in infants and children |journal=Crit. Care Med. |volume=20 |issue=2 |pages=193–9 |date=February 1992 |pmid=1737455 |doi= |url=}}</ref><ref name="pmid23182526">{{cite journal |vauthors=Kollef MH |title=Ventilator-associated complications, including infection-related complications: the way forward |journal=Crit Care Clin |volume=29 |issue=1 |pages=33–50 |date=January 2013 |pmid=23182526 |doi=10.1016/j.ccc.2012.10.004 |url=}}</ref><ref name="pmid22070009">{{cite journal |vauthors=Drašković B, Rakić G |title=[Complications of mechanical ventilation] |journal=Srp Arh Celok Lek |volume=139 |issue=9-10 |pages=685–92 |date=2011 |pmid=22070009 |doi= |url=}}</ref><ref name="pmid20017891">{{cite journal |vauthors=Wittekamp BH, van Mook WN, Tjan DH, Zwaveling JH, Bergmans DC |title=Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients |journal=Crit Care |volume=13 |issue=6 |pages=233 |date=2009 |pmid=20017891 |pmc=2811912 |doi=10.1186/cc8142 |url=}}</ref><ref name="pmid25279009">{{cite journal |vauthors=Charles MP, Kali A, Easow JM, Joseph NM, Ravishankar M, Srinivasan S, Kumar S, Umadevi S |title=Ventilator-associated pneumonia |journal=Australas Med J |volume=7 |issue=8 |pages=334–44 |date=2014 |pmid=25279009 |pmc=4157153 |doi=10.4066/AMJ.2014.2105 |url=}}</ref><ref name="pmid19186407">{{cite journal |vauthors=Valencia M, Torres A |title=Ventilator-associated pneumonia |journal=Curr Opin Crit Care |volume=15 |issue=1 |pages=30–5 |date=February 2009 |pmid=19186407 |doi= |url=}}</ref><ref name="pmid25029020">{{cite journal |vauthors=Kalanuria AA, Ziai W, Zai W, Mirski M |title=Ventilator-associated pneumonia in the ICU |journal=Crit Care |volume=18 |issue=2 |pages=208 |date=March 2014 |pmid=25029020 |pmc=4056625 |doi=10.1186/cc13775 |url=}}</ref><ref name="pmid9238976">{{cite journal |vauthors=Keithley JK |title=Nutritional needs and support of mechanically ventilated patients |journal=Medsurg Nurs |volume=6 |issue=2 |pages=74–5 |date=April 1997 |pmid=9238976 |doi= |url=}}</ref> | ||
=== Oxygen toxicity === | === Oxygen toxicity === | ||
* Proportional to the duration and degree of increased oxygen delivery (FiO2 >0.6) | * Proportional to the duration and degree of increased [[oxygen]] delivery (FiO2 >0.6) | ||
=== Ventilator-associated pneumonia === | === Ventilator-associated pneumonia === |
Latest revision as of 16:02, 4 April 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Complications of mechanical ventilation include, oxygen toxicity, ventilator associated pneumonia (VAP), laryngeal edema and ulceration, malnutrition, oversedation/delirium and ventilator induced lung injury.
Complications
Mechanical ventilation is associated with the following complications:[1][2][3][4][5][6][7][8][9][10][11]
Oxygen toxicity
- Proportional to the duration and degree of increased oxygen delivery (FiO2 >0.6)
Ventilator-associated pneumonia
- Ventilator associated pneumonia has a mortality rate of 30 percent
- Typical pathogens include:
- Methicillin resistant staphylococcus aureus (MRSA)
- Pseudomonas
- Acinetobacter
- Enterobacter
- Preventative strategies include washing hands, head of bed elevated, non-nasal intubation, enteral nutrition rather than total prenteral nutrition (TPN), routine suction of subglottic secretions, avoidance of unnecessary antibiotics and transfusions, routine oral antispetic, stress ulcer prophylaxis with sucralfate, silver-coated tubes
Laryngeal
- Edema (for patients on vent for > 36 hours)
- Predicted by positive cuff leak test
- Treat using methylprednisolone 20 mg IV q 4h, starting 12 h pre-extubation (decrease re-intubation rates)
- Ulceration
- Consider tracheostomy in patients who require mechanical ventilation for for > 14 days
Malnutrition
- All critically ill patients are at risk of becomming malnourished
- Early eneteral nutrition should be encouraged in patients
- Preventative strategies include checking gastric residuals, permissive enteral underfeeding (half of calculated caloric requirement)
- Parenteral nutrition should be delayed until after day 8 to decrease risk of infections and cholestasis
Oversedation/Delirium
- Benzodiazepines and polypharmacy increase the risk of delirium
- Propofol may lead to hypotension (propofol infusion syndrome)
Ventilator induced lung injury
References
- ↑ Pierson DJ (July 1990). "Complications associated with mechanical ventilation". Crit Care Clin. 6 (3): 711–24. PMID 2199002.
- ↑ Wang GC, Kao HA, Hwang FY, Ho MY, Hsu CH, Hung HY (1991). "[Complications in the use of mechanical ventilator in newborns: one year's experience]". Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi (in Chinese). 32 (4): 227–32. PMID 1776449.
- ↑ Principi T, Fraser DD, Morrison GC, Farsi SA, Carrelas JF, Maurice EA, Kornecki A (May 2011). "Complications of mechanical ventilation in the pediatric population". Pediatr. Pulmonol. 46 (5): 452–7. doi:10.1002/ppul.21389. PMID 21194139.
- ↑ Rivera R, Tibballs J (February 1992). "Complications of endotracheal intubation and mechanical ventilation in infants and children". Crit. Care Med. 20 (2): 193–9. PMID 1737455.
- ↑ Kollef MH (January 2013). "Ventilator-associated complications, including infection-related complications: the way forward". Crit Care Clin. 29 (1): 33–50. doi:10.1016/j.ccc.2012.10.004. PMID 23182526.
- ↑ Drašković B, Rakić G (2011). "[Complications of mechanical ventilation]". Srp Arh Celok Lek. 139 (9–10): 685–92. PMID 22070009.
- ↑ Wittekamp BH, van Mook WN, Tjan DH, Zwaveling JH, Bergmans DC (2009). "Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients". Crit Care. 13 (6): 233. doi:10.1186/cc8142. PMC 2811912. PMID 20017891.
- ↑ Charles MP, Kali A, Easow JM, Joseph NM, Ravishankar M, Srinivasan S, Kumar S, Umadevi S (2014). "Ventilator-associated pneumonia". Australas Med J. 7 (8): 334–44. doi:10.4066/AMJ.2014.2105. PMC 4157153. PMID 25279009.
- ↑ Valencia M, Torres A (February 2009). "Ventilator-associated pneumonia". Curr Opin Crit Care. 15 (1): 30–5. PMID 19186407.
- ↑ Kalanuria AA, Ziai W, Zai W, Mirski M (March 2014). "Ventilator-associated pneumonia in the ICU". Crit Care. 18 (2): 208. doi:10.1186/cc13775. PMC 4056625. PMID 25029020.
- ↑ Keithley JK (April 1997). "Nutritional needs and support of mechanically ventilated patients". Medsurg Nurs. 6 (2): 74–5. PMID 9238976.