Complications of Mechanical Ventilation

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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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