Mechanical ventilation complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Complications

Mechanical ventilation is associated with the following complications:

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)