Mechanical ventilation complications: Difference between revisions
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==Overview== | ==Overview== | ||
Complications of mechanical ventilation include, oxygen toxicity, ventilator associated pneumonia (VAP), laryngeal edema and ulceration, malnutrition, oversedation/delirium and ventilator induced lung injry. | |||
==Complications== | ==Complications== |
Revision as of 16:26, 26 March 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 injry.
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)