This document discusses the complications that can arise from mechanical ventilation through either invasive or non-invasive means. Some key complications mentioned include pneumonia, infections, injuries to the face/lips/pharynx and larynx/trachea, gastrointestinal effects like esophagitis and decreased motility, renal effects from reductions in blood pressure/flow, disrupted sleep, and decubitus ulcers. Proper diagnosis and management of these various complications is important for patients receiving mechanical ventilation support.

1. COMPLICATIONS
OF ARTIFICIAL AIRWAY APPLICATION
Dr Nisar Ahmed Arain
Assistant Professor
Anesthesia/Critical Care/ER
DIAGNOSIS AND MANAGEMENT
OF THESE COMPLICATIONS

2. -Mechanical ventilations
and its requirements
-A mode of assisted or controlled
ventilation using mechanical
devices that cycle automatically
to generate airway pressure

3. -TYPES OF
MECHANICAL VENTILATION
--1-INVASIVE MECHANICAL VENTILATION
and
--2-NON INVASIVE MECHANICAL VENTILATION

4. -INVASIVE
MECHANICAL VENTILATION
--This is defined as mechanical ventilation
working via an artificial airway which can
either be via Endotracheal tube or via
tracheostomy tube

5. -NON INVASIVE
MECHANICAL VENTILATION
-Non invasive ventilation (NIV)
refers to the administration of
ventilatory support without
using an invasive artificial airway

6. -INDICATIONS
--1-Acute Pulmonary edema
--2-Pneumonia
--3-ARDS
--4-Severe Asthmatic attack
--5-Severe acute exacerbation
of COPD
--6-Guillain – Barre syndrome
--7-Mysthenia Gravis
--8-Drug over dose
--9-Shock
--10-Severe sepsis

7. -COMPLICATIONS OF VENTILATION
-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

8. -COMPLICATIONS
OF VENTILATION
--HYPOTENSION
--INFECTION
--PNEUMONIA
---One of the most serious and common risks of being on a
Ventilator is PNEUMONIA . The breathing tube that is put in
The airway can allow Bacteria to enter your Lungs. As a result
this may develop ventilator associated pneumonia (VAP)
-NOSOCOMIAL INFECTION
(GRAM NEGATIVE ORGANISMS
--1-Enterobacteria spp
--2-Escherchia coli
--3-Klebsiella spp
--4-Proteus spp
--5-Pseudomonas Aeruginosa
--6-Acinetobactor spp
--7-Staphlococus aureus
As a result

9. -INJURIES TO THE
-FACE LIPS and PHARYNX
--Trauma to the lips and cheeks from
the tube
--Injuries to the tongue particularly
when entrapped between the
Endotracheal tube and the Teeth

10. -LARYNGEAL INJURIES
--Some degree of Glottic injury is seen in
94% of patients Intubated for 4 days or
longer
--Erosive Ulcers of vocal cords can be there
--Swelling and edema of the vocal cords may
be there
-Granuloma’s (7% in patients intubated for
4 days or more

11. -TRACHEAL INJURIES
--1-Cuff pressure creates Tracheal damage as following
a-Tracheal Ulcerations
b-Edema and submucosal Hemorrhage
--2-Tracheal Dilatation
--3-Tracheal Stenosis

12. -GASTRO – INTESTINAL EFFECTS
-ESOPHAGUS, STOMACH
and SMALL INTESTINE
--Erosive esophagitis (30% to 50% of patients ventilated
for more then 4 hours
--Reasons by the adjuncts of Tracheal intubation
a-NG tube
b-Poor lower esophageal sphincter Tone and Reflux
c-Duodeno – Gastro – esophageal reflux through the
action of enzyme Trypsin
--Upper Gastrointestinal Hemorrhage
a-Stress
b-Decreased Gastric Mucosal protection secondary to
a fall in splanchnic blood flow
--Decreased motility of stomach and small intestine

13. -LIVER and GALL BLADDER
---Reduction in Portal Blood
Flow secondary to fall in
Cardiac output
--Hepatic Engorgement
--Reduction in drug clearance
secondary to reduction
of hepatic blood flow

14. --LARGE BOWEL
--1-Constipation
--2-Abdominal Distension

15. -RENAL EFFECTS
--1-The usual renal response to
reduction of Cardiac output
and Mean arterial pressure
--2-Reduction in urine output
secondary to a fall in the
Transmural pressure of the
right atrium that results in the
reduction of the secretion of
the “Atrial – natriuretic – peptide
and the activation of
“Renin – angiotensin –
aldosterone” system and pituitary
vasopressin secretion

16. -DISRUPT SLEEP
--1-Noice disruption
--2-Ventilator alarm disruption
a-Inappropriate threshold
b-Delayed alarm inactivation
--3-Humidifier alarms
--4-Disrution of nursing interventions
a-Airway suction
b-Nebulizer delivery
--5-Ventillation – related pharmacological
disruption
a-Benzodiazepines
b-Opioids

17. -DECUBITUS ULCERS
--1-Malnutritian
--2-Depression and Anxiety
--3-Delirium