COMPLICATION OF LONG TERM MECHENICAL VENTILATION

K.A.S.PRIYANTHAMD/BN/2011/196

B.Sc NursingFaculty of medicine

University of Ruhuna.

MECHANICAL VENTILATION

“A mode of assisted or controlled ventilation using mechanical devices that cycle automatically to generate airway pressure.”

(The American Heritage Medical dictionary)

MECHANICAL VENTILATION

1.Invasive mechanical ventilation.

2.Non-Invasive mechanical ventilation.

Invasive mechanical ventilation

Defined as mechanical ventilation via an artificial airway which can either be via endotracheal tube or tracheostomy tube.

Non-Invasive mechanical ventilation“Noninvasive ventilation (NIV) refers to the administration of ventilatory support without using an invasive artificial airway”

indication1. Acute pulmonary oedema 2. Pneumonia 3. ARDS 4. Severe asthmatic attack 5. Severe acute exacerbation of COPD 6. Guillain-Barre syndrome 7. Myasthenia gravis 8. Drug overdose 9. Shock 10. Severe sepsis

COMPLICATION OF LONG TERM VENTILATION1.INFECTION

PneumoniaOne of the most serious and common risks of being on a ventilator is pneumonia. The breathing tube that's put in the airway can allow bacteria to enter your lungs. As a result,may develop ventilator-associated pneumonia (VAP).

Nosocomial infction(Gram-negative organisms)Enterobcter sppEscherichia coliKlebsiella sppProteus sppPseudomonas aeruginosaAcinetobacter sppStapylococus aureus

2.PNEUMOTHORAX

This is a condition in which air leaks out of the lungs and into the space between the lungs and the chest wall. This can cause pain and shortness of breath, and it may cause one or both lungs to collapse.

3.INJURIES TO FACE, LIPS AND OROPHARYNX

Trauma to the lip and checks from the tube tie.

Injuries to the tongue particularly when entrapped between the endotracheal tube and the lower teeth.

4.LARYNGEAL INJURIES

Some degree of glottic injury is seen in 94% of patients intubated for 4 days or longer

Erosive ulcers of vocal cords.Swelling and edema of the vocal cords.Granulomas (7% in patients intubated for 4

days or more)

5.TRACHEAL INJURIES

Cuff pressure tracheal damage: tracheal ulceration, edema and submucosal hemmorrhage

Tracheal dilatationTracheal stenosis

6.HYPOTENSION

7.GASTROINTESTINAL EFFECTS

Esophagus,Stomach and Small Intestine

Erosive esophagitis (30-50% of patients ventilated >48 hours)NG tubePoor lower esophageal sphincter tone and refluxOpiates and adrenergic agonistsDuodenogastroesophageal reflux through the action of trypsin

Upper gastrointestinal hemorrhage:StressDecreased gastric mucosal protection secondary to a fall in

splanchnic blood flowDecreased motility of stomach and small intestine

Liver and Gallbladder

Reduction in portal venous flow secondary to the fall in cardiac output.

Hepatic engorgement.Reduction in drug clearance secondary to

reduction of hepatic blood flow.

Large Bowel

ConstipationAbdominal distension

8.RENAL EFFECTS

The usual renal response to reduction of cardiac output and mean arterial pressure.

Reduction in urine output secondary to a fall in the transmural pressure of the right atrium that results in reduction of the secretion of atrial naturitic peptide and the activation of renin-angiotensin-aldosterone system and pituitary vasopressin secretion

9.DISRUPT SLEEP

Noise disruptionVentilator alarm:

inappropriate thresholdDelayed alarm inactivation

Humidifier alarmsDisruption by nursing interventions

o Airway suctiono Nebulizer delivery

Ventilation-related pharmacological disruption o Benzodiazepineso Oipoids

10.DECUBITUS ULCERS

11.MALNUTRITION

12.DEPRESSHION & ANXIETY

13.DELEIRIUM