Complications of Mechanical Ventilators

Question 1

Physiologic Complications

Answer 1

• Ventilator-Induced Lung Injury
  > Barotrauma
  > Air leaks: excessive pressure in alveoli, excessive vol in alveoli, shearing caused by repeated opening & closing of alveoli
• Cardiovascular Compromise
  > positive pressure ventilation dcrs preload, dcr in cardiac output
  > hepatic & renal dysfunction may occur
• Gastrointestinal Disturbances
  > occur as a result of positive-pressure vent
• Ventilator assisted pneumonia
  > 48-72 hrs after endo intubation

Question 2

Prevention of Complications

Answer 2

• Positioning
  > semirecumbant position
  > HOB greater than 30
• Sedation Vacation
  > a daily reduction of sedation to evaluate ot
  > not appropriate for all pts; coma, incrd ICP
• Suctioning
  > subglottic & regular suctioning
• Use appropriate tidal vol & lowest amnt of PEEP for therapeutic response

Question 3

Air Leak Disorder: Barotrauma

Answer 3

• Air enters the interstitial space (from alveolar rupture) then travels through the pulmonary interstitium (pulmonary intersitial emphysema) and lands in various places in the body
  > Pleural space (pneumothorax & tension pneumo)
  > Subcutaneous tissues (subcutaneious emphysema)
• Usually benign, except for pneumothorax & tension pneumo

Question 4

Air Leak Disorder: Subcutaneous Emphysema

crepitus
assessment
tx

Answer 4

• Result of excessive pressure inthe alveoli tht lead to extreme alveolar wall stress & damage to alveolar-capillary membrane, causing air to escape into surrounding spaces
• Assessment: crepitus, usually around face, eyes, neck, upper chest
• Treatment: optimize oxygenation & ventilation, incr FiO2, dcr PEEP

Question 5

Air Leak Disorder: Pneumothorax

Answer 5

• The accumulation of air or other gas in the pleural space tht, if large enough, compresses the lung
• The affected area of lung will collapse, and the alveoli become under-ventilated

Question 6

Air Leak Disorder: Pneumothorax

assessment
treatment

Answer 6

• Assessment:
  > subcutaneous emphysema
  > a large pneumo: incrd RR, incrd HR, anxiety, possibly cyanosis, breath sounds dcrd or absent, unequal chest expansion
• Treatment:
  > if pt is not in distress, optimize oxygenation & ventilation
• not an emergency unless cyanotic

Question 7

Air Leak Disorder: Tension Pneumothorax

Answer 7

• Air enters the pleural space on inhalation & cannot exit on exhalation causing the pressure in the pleural space to incr
• The lung will collapse when the pressure is high enough
• Air bubble keeps getting bigger & bigger, pt not stable
• Respiratory acidosis

Question 8

Air Leak Disorder: Tension Pneumothorax

assessment
treatment

Answer 8

• Assessment: shifting of the mediastinum & trachea to the unaffected side, diminished breath sounds, hyperrresonance to percussion, tachycardia, & hypotension
• Treatment: supplemental oxygen (or incr FiO2), prepare for insertion of chest tube

Question 9

Air Leak Disorders: Medical Management

Answer 9

• Management depends on severity
  > assess pt
  > x-ray
• Small pneumo: supplemental oxygen, incr FiO2
• A large pneumo (<15%) & tension pneumo requires intervention to excuate air from pleural space
  > needle decompression
  > chest tube

Question 10

Air Leak Disorders: Nursing Management

Answer 10

• Optimize oxygenation & ventilation
  > incr FiO2, suction
• Maintain chest tube drainage system
• Assess for complications
  > crepitus
  > cyanosis