Complication of long term ventilation

there were short description about mechanical ventilation

1. COMPLICATION OF LONG TERM MECHENICAL VENTILATION K.A.S.PRIYANTHA MD/BN/2011/196 B.Sc Nursing Faculty of medicine University of Ruhuna .

2. MECHANICAL VENTILATION “ A mode of assisted or controlled ventilation using mechanical devices that cycle automatically to generate airway pressure .” (The American Heritage Medical dictionary)

3. MECHANICAL VENTILATION 1.Invasive mechanical ventilation. 2.Non-Invasive mechanical ventilation.

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

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

6. indication 1. 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

7. COMPLICATION OF LONG TERM VENTILATION 1.INFECTION Pneumonia One 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 spp Escherichia coli Klebsiella spp Proteus spp Pseudomonas aeruginosa Acinetobacter spp Stapylococus aureus

8. 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.

9. 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.

10. 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)

11. 5.TRACHEAL INJURIES Cuff pressure tracheal damage: tracheal ulceration, edema and submucosal hemmorrhage Tracheal dilatation Tracheal stenosis

12. 6.HYPOTENSION

13. 7.GASTROINTESTINAL EFFECTS Esophagus,Stomach and Small Intestine Erosive esophagitis (30-50% of patients ventilated >48 hours) NG tube Poor lower esophageal sphincter tone and reflux Opiates and adrenergic agonists Duodenogastroesophageal reflux through the action of trypsin Upper gastrointestinal hemorrhage: Stress Decreased gastric mucosal protection secondary to a fall in splanchnic blood flow Decreased motility of stomach and small intestine

14. 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.

15. Large Bowel Constipation Abdominal distension

16. 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

17. 9.DISRUPT SLEEP Noise disruption Ventilator alarm: inappropriate threshold Delayed alarm inactivation Humidifier alarms Disruption by nursing interventions Airway suction Nebulizer delivery Ventilation-related pharmacological disruption Benzodiazepines Oipoids

18. 10.DECUBITUS ULCERS 11.MALNUTRITION 12.DEPRESSHION & ANXIETY 13.DELEIRIUM