This document discusses mechanical ventilation and its complications. It begins by defining mechanical ventilation as assisted or controlled ventilation using mechanical devices. It then describes invasive mechanical ventilation, which uses an endotracheal or tracheostomy tube, and non-invasive ventilation without an artificial airway. Common indications for mechanical ventilation are then listed. The main body discusses complications of long-term ventilation, including infections like pneumonia, pneumothorax, injuries to the face and airway, gastrointestinal effects, renal effects, disrupted sleep, decubitus ulcers, malnutrition, depression/anxiety, and delirium.

1. 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
o Airway suction
o Nebulizer delivery
 Ventilation-related pharmacological disruption
o Benzodiazepines
o Oipoids

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