complications of artificial applications part-5-Anesthesia

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