Complications of Mechanical Ventilation

Respiratory_therapist
Barotrauma
-    Presence of extra alveolar air
–    This air may escape (usually due to alveolar or bleb rupture)
–    May occur when the alveoli are over distended such as with positive pressure ventilation, high tidal volumes or PEEP
–    Signs & Symptoms: increased PIP, decreased breath sounds, tracheal shift, hypoxemia
–    Could worsen to tension pneumothorax

-    Cardiovascular
–    Decreased venous return and CO
–    May be manifested by decreased BP, decreased urinary output, weak pulses, fatigue

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-    Gastrointestinal
–    Stress ulcers and GI bleeding
–    Distention
–    Malnutrition: atrophy of respiratory muscles, – protein,
– albumin, – immunity, – surfactant production, impaired cellular oxygenation, and central respiratory depression

-    Inadequate Ventilation
-    Intubation of right mainstem bronchus
–    ETT out of position/extubation
–    Incompatible settings
–    Operator error
-    Tracheal Damage/Necrosis
-    The systolic pressure in mucosal vessels of the trachea normally 20 – 25 mmHg
»    Leaks
-    Can cause a decrease in tidal volume
–    Check all ventilator tubing for disconnections or leaking
–    Can be leaking at cuff of airway or one – way valve of airway
-    Resistance / Obstruction of Airway
–    Usually caused by situations which – compliance
–    May be equipment related: ETT kinked, water in tubing, patient biting ETT
–    May be patient related: secretions, bronchospasm, atelectasis, “bucking” ventilator

-    Acid – Base Disturbances
-    Respiratory alkalosis versus respiratory acidosis
–    O2 Toxicity
–    Occurs with high concentrations of oxygen (FIO2 60%)
-    Aspiration
–    Gastric distention, impaired gastric emptying and esophageal  reflux  predispose patient to aspiration

-    Infection
–    Patients with artificial airways are at increased risk for pulmonary infection
–    ETT suctioning can also predispose the patient to infection and frequently cause nosocomial infection
–    Urinary Tract Infection.
–    Septicemia

-    Water Imbalance
–    Water  and salt retention.
–    Reduce ionized calcium.

-    Immobility
-    Complications:  muscle weakness/wasting, contractures, loss of skin integrity, pneumonia, DVT ,  and constipation.

-    Psychological Complications
-    Patient may experience stress/anxiety due to being on a machine to breathe
–    Communication becomes challenging
–    Loses autonomy/control over care
–    Altered sleep pattern may occur
–    Depression may occur
–    Ventilator Dependence/ Inability to Wean
–    Patients who require long term ventilation are usually very challenging when it comes to weaning.

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