Mechanical ventilation complications

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

## Overview

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Complications of mechanical ventilation include, oxygen toxicity, ventilator associated pneumonia (VAP), laryngeal edema and ulceration, malnutrition, oversedation/delirium and ventilator induced lung injury.

## Complications

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Mechanical ventilation is associated with the following complications:[1][2][3][4][5][6][7][8][9][10][11]

### Oxygen toxicity

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* Proportional to the duration and degree of increased oxygen delivery (FiO2 >0.6)

### Ventilator-associated pneumonia

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* 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

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* 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

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* 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

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* Benzodiazepines and polypharmacy increase the risk of delirium
* Propofol may lead to hypotension (propofol infusion syndrome)

### Ventilator induced lung injury

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## References

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1. ↑ Pierson DJ (July 1990). "Complications associated with mechanical ventilation". Crit Care Clin. 6 (3): 711–24. PMID 2199002.
2. ↑ Wang GC, Kao HA, Hwang FY, Ho MY, Hsu CH, Hung HY (1991). "[Complications in the use of mechanical ventilator in newborns: one year's experience]". Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi (in Chinese). 32 (4): 227–32. PMID 1776449.CS1 maint: Unrecognized language (link)
3. ↑ Principi T, Fraser DD, Morrison GC, Farsi SA, Carrelas JF, Maurice EA, Kornecki A (May 2011). "Complications of mechanical ventilation in the pediatric population". Pediatr. Pulmonol. 46 (5): 452–7. doi:10.1002/ppul.21389. PMID 21194139.
4. ↑ Rivera R, Tibballs J (February 1992). "Complications of endotracheal intubation and mechanical ventilation in infants and children". Crit. Care Med. 20 (2): 193–9. PMID 1737455.
5. ↑ Kollef MH (January 2013). "Ventilator-associated complications, including infection-related complications: the way forward". Crit Care Clin. 29 (1): 33–50. doi:10.1016/j.ccc.2012.10.004. PMID 23182526.
6. ↑ Drašković B, Rakić G (2011). "[Complications of mechanical ventilation]". Srp Arh Celok Lek. 139 (9–10): 685–92. PMID 22070009.
7. ↑ Wittekamp BH, van Mook WN, Tjan DH, Zwaveling JH, Bergmans DC (2009). "Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients". Crit Care. 13 (6): 233. doi:10.1186/cc8142. PMC 2811912. PMID 20017891.
8. ↑ Charles MP, Kali A, Easow JM, Joseph NM, Ravishankar M, Srinivasan S, Kumar S, Umadevi S (2014). "Ventilator-associated pneumonia". Australas Med J. 7 (8): 334–44. doi:10.4066/AMJ.2014.2105. PMC 4157153. PMID 25279009.
9. ↑ Valencia M, Torres A (February 2009). "Ventilator-associated pneumonia". Curr Opin Crit Care. 15 (1): 30–5. PMID 19186407.
10. ↑ Kalanuria AA, Ziai W, Zai W, Mirski M (March 2014). "Ventilator-associated pneumonia in the ICU". Crit Care. 18 (2): 208. doi:10.1186/cc13775. PMC 4056625. PMID 25029020.
11. ↑ Keithley JK (April 1997). "Nutritional needs and support of mechanically ventilated patients". Medsurg Nurs. 6 (2): 74–5. PMID 9238976.

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