scholarly journals Complications of mechanical ventilation

2011 ◽  
Vol 139 (9-10) ◽  
pp. 685-692
Author(s):  
Biljana Draskovic ◽  
Goran Rakic
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Lung Damage ◽  
Mechanically Ventilated ◽  
Artificial Airway ◽  
Organic Systems ◽  
Vital Functions ◽  
Care Workers ◽  
Inflammatory Processes ◽  
Ventilation Of The Lungs

Mechanical ventilation of the lungs, as an important therapeutic measure, cannot be avoided in critically ill patients. However, when machines take over some of vital functions there is always a risk of complications and accidents. Complications associated with mechanical ventilation can be divided into: 1) airway-associated complications; 2) complications in the response of patients to mechanical ventilation; and 3) complications related to the patient?s response to the device for mechanical ventilation. Complications of artificial airway may be related to intubation and extubation or the endotracheal tube. Complications of mechanical ventilation, which arise because of the patient?s response to mechanical ventilation, may primarily cause significant side effects to the lungs. During the last two decades it was concluded that mechanical ventilation can worsen or cause acute lung injury. Mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma), it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma) and may cause subtle damages due to the activation of inflammatory processes (biotrauma). Complications caused by mechanical ventilation, beside those involving the lungs, can also have significant effects on other organs and organic systems, and can be a significant factor contributing to the increase of morbidity and mortality in critically ill of mechanically ventilated patients. Complications are fortunately rare and do not occur in every patient, but due to their seriousness and severity they require extensive knowledge, experience and responsibility by health-care workers.

scholarly journals Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yongfang Zhou ◽  
Steven R. Holets ◽  
Man Li ◽  
Gustavo A. Cortes-Puentes ◽  
Todd J. Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
History Of ◽  
Training Background ◽  
The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

scholarly journals Selection strategy for sedation depth in critically ill patients on mechanical ventilation

2021 ◽  
Vol 21 (S2) ◽  
Author(s):  
Longxiang Su ◽  
Chun Liu ◽  
Fengxiang Chang ◽  
Bo Tang ◽  
Lin Han ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Dimensionality Reduction ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Latent Profile Analysis ◽  
Profile Analysis ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Sedation And Analgesia ◽  
Ventilated Patients

Abstract Background Analgesia and sedation therapy are commonly used for critically ill patients, especially mechanically ventilated patients. From the initial nonsedation programs to deep sedation and then to on-demand sedation, the understanding of sedation therapy continues to deepen. However, according to different patient’s condition, understanding the individual patient’s depth of sedation needs remains unclear. Methods The public open source critical illness database Medical Information Mart for Intensive Care III was used in this study. Latent profile analysis was used as a clustering method to classify mechanically ventilated patients based on 36 variables. Principal component analysis dimensionality reduction was used to select the most influential variables. The ROC curve was used to evaluate the classification accuracy of the model. Results Based on 36 characteristic variables, we divided patients undergoing mechanical ventilation and sedation and analgesia into two categories with different mortality rates, then further reduced the dimensionality of the data and obtained the 9 variables that had the greatest impact on classification, most of which were ventilator parameters. According to the Richmond-ASS scores, the two phenotypes of patients had different degrees of sedation and analgesia, and the corresponding ventilator parameters were also significantly different. We divided the validation cohort into three different levels of sedation, revealing that patients with high ventilator conditions needed a deeper level of sedation, while patients with low ventilator conditions required reduction in the depth of sedation as soon as possible to promote recovery and avoid reinjury. Conclusion Through latent profile analysis and dimensionality reduction, we divided patients treated with mechanical ventilation and sedation and analgesia into two categories with different mortalities and obtained 9 variables that had the greatest impact on classification, which revealed that the depth of sedation was limited by the condition of the respiratory system.

The Feasibility of Objective Sleep-Quality Assessment in an ICU Setting

2021 ◽  
Vol 104 (2) ◽  
pp. 304-309
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Sleep Quality ◽  
Acute Respiratory Failure ◽  
Critically Ill ◽  
Sleep Stages ◽  
Poor Sleep ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Background: Sleep disruptions frequently occur in hospitalized patients, especially with critically ill, mechanically ventilated patients. Severely altered sleep architectures result in unclassifiable sleep stages as listed by the conventional Rechtschaffen and Kales (R&K) criteria, and a new classification for sleep scoring including atypical sleep (AS) and pathological wakefulness (PW) has recently been proposed. Objective: To demonstrate the feasibility of performing objective sleep qualification in patients receiving mechanical ventilation due to acute respiratory failure. Materials and Methods: In the present prospective cohort study, polysomnography was performed in 38 patients requiring invasive mechanical ventilation due to acute respiratory failure at the respiratory care unit (RCU) of Siriraj Hospital between February and December 2017. Their sleep stages were analyzed by conventional rules and the new classifications of AS and PW. The associations between the presence of AS or PW and the patients’ characteristics were analyzed. Correlations between sleep quality and clinical parameters were also determined. Results: Most of the patients had poor sleep quality with median sleep efficiency (IQR) of 35.9% (18.5, 62.3) and significantly decreased slowwave sleep [median (IQR) 0.4% (0.00, 5.70)] and REM [median (IQR) 1.3% (0.00, 6.43)]. According to the new classifications, 14 out of 38 (prevalence of 36.8%) mechanically ventilated patients had AS. The prevalence of PW and either AS or PW were 36.8% and 52.6%, respectively. A higher baseline respiratory rate was observed among patients who had either AS or PW at 24 versus 20 breaths/minute (p=0.02), while a longer duration of mechanical ventilator support was found in patients with PW at nine versus five (p=0.003). Patient-ventilator asynchrony was also noted in all patients. Conclusion: Sleep quality among critically ill and mechanically ventilated patients was severely disturbed. A higher prevalence of AS and PW were noted. The technical feasibility of sleep recording in Thai intensive care unit (ICU) settings was established. Keywords: Polysomnography, Atypical sleep, ICU

scholarly journals A study on symptoms of children mechanically ventilated in a paediatric intensive care unit of a minimum resource setting in tertiary care centre

2019 ◽  
Vol 6 (2) ◽  
pp. 574
Author(s):  
Korisipati Ankireddy ◽  
Aruna Jyothi K.
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Tertiary Care ◽  
Limited Resource ◽  
Critically Ill Children ◽  
Invasive Ventilation ◽  
Ventilator Support ◽  
Mechanically Ventilated

Background: Mechanical ventilation, a lifesaving intervention in a critical care unit is under continuous evolution in modern era. Despite this, the management of children with invasive ventilation in developing countries with limited resources is challenging. The study analyses the clinical profile, indications, complications and duration of ventilator care in limited resource settings. Methods: A retrospective study of critically ill children mechanically ventilated in an intensive care unit of a tertiary care government hospital.   Results: A total of 120 children required invasive ventilation during the study period of 1 year. Infants constituted the majority (70%), and males (65%) were marginally more than female children (35%). Respiratory failure was the most common indication for invasive ventilation (55%). The major underlying etiology for invasive ventilation was bronchopneumonia associated with septic shock (30%); and the same also required a prolonged duration of ventilation of >72 hours (35%). Prolonged ventilator support of >72 hours predisposed to more complications as well as a prolonged hospital stay of >2 weeks and above, which was statistically significant. Upper lobe atelectasis (50%) and ventilator associated pneumonia (25%) were the major complications. The mortality rate of present study population was 40% as opposed to the overall mortality of 10%.   Conclusions: Present study highlights that critically ill children can be managed with mechanical ventilation even in limited resource settings. The child should be assessed clinically regarding the tolerance to extubation every day, to minimise the complications associated with prolonged ventilator support.

scholarly journals Neuromonitoring of delirium with quantitative pupillometry In sedated mechanically ventilated critically ill patients

2020 ◽  
Author(s):  
Eva Favre ◽  
Adriano Bernini ◽  
Paola Morelli ◽  
Jerôme Pasquier ◽  
John-Paul Miroz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Brain Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Potential Utility ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
Increased Risk ◽  
Infrared Pupillometry ◽  
Icu Delirium

Abstract Background. Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential utility in patients at risk of ICU delirium is unknown. Methods. This was an observational cohort study of medical-surgical ICU patients, without acute or known primary brain injury, who underwent sedation and mechanical ventilation for at least 48 hours. Starting at day 3, automated infrared pupillometry – blinded to ICU caregivers – was used for repeated measurement of the pupillary function, including quantitative pupillary light reflex (q-PLR, expressed as % pupil constriction to a standardized light stimulus) and constriction velocity (CV, mm/sec). The relationship between delirium, using the CAM-ICU score, and quantitative pupillary variables was examined. Results. A total of 59/100 patients had ICU delirium, diagnosed at a median 8 (5-13) days from admission. Compared to non-delirious patients, subjects with ICU delirium had lower values of q-PLR (25 [19-31] vs. 20 [15-28] %) and CV (2.5 [1.7-2.8] vs. 1.7 [1.4-2.4] mm/sec) at day 3, and at all additional time-points tested ( p <0.05). After adjusting for the SOFA score and the cumulative dose of analgesia and sedation, lower q-PLR was associated with an increased risk of ICU delirium (OR 1.057 [1.007-1.113] at day 3; p =0.03). Conclusions. Sustained abnormalities of quantitative pupillary variables at the early ICU phase correlate with delirium and precede clinical diagnosis by a median 5 days. These findings suggest a potential utility of quantitative pupillometry in sedated mechanically ventilated ICU patients at high risk of delirium.

scholarly journals Ventilator Circuits, Humidification and Ventilator-Associated Pneumonia

1996 ◽  
Vol 3 (6) ◽  
pp. 397-402
Author(s):  
Dean Hess
Keyword(s):  
Mechanical Ventilation ◽  
Moisture Loss ◽  
Ventilator Associated Pneumonia ◽  
Ventilator Circuit ◽  
Mechanically Ventilated ◽  
Artificial Airway ◽  
Condensate Formation ◽  
Heated Humidifiers ◽  
Technical Issues ◽  
Heat And Moisture

Technical issues in the care of mechanically ventilated patients include those related to the ventilator circuit, humidification and ventilator-associated pneumonia. Principal issues related to ventilator circuits include leaks and compression volume. Circuit compression volume affects delivered tidal volume as well as measurements of auto-positive end-expiratory pressure and mixed expiredPCO2. Resistance through the ventilator circuit contributes to patient-ventilator dyssynchrony during assisted modes of mechanical ventilation. Adequate humidification of inspired gas is necessary to prevent heat and moisture loss. Common methods of humidification of inspired gas during mechanical ventilation include use of active heated humidifiers and passive artificial noses. Artificial noses are less effective than active humidifiers and are best suited to short term use. With active humidifiers, the circuit can be heated to avoid condensate formation. However, care must be exercised when heated circuits are used to avoid delivery of a low relative humidity and subsequent drying of secretions in the artificial airway. Although pneumonia is a complication of mechanical ventilation, these pneumonias are usually the result of aspiration of pharyngeal secretions and are seldom related to the ventilator circuit. Ventilator circuits do not need to be changed more frequently than weekly for infection control purposes, and the incidence of ventilator-associated pneumonia may be greater with more frequent circuit changes.

scholarly journals Closed-Loop Versus Conventional Mechanical Ventilation in COVID-19 ARDS

2021 ◽  
pp. 088506662110241
Author(s):  
Pedro David Wendel Garcia ◽  
Daniel Andrea Hofmaenner ◽  
Silvio D. Brugger ◽  
Claudio T. Acevedo ◽  
Jan Bartussek ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Odds Ratio ◽  
Closed Loop ◽  
Conventional Mechanical Ventilation ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Mechanically Ventilated ◽  
Ventilation Time ◽  
Mechanical Ventilation Time

Background: Lung-protective ventilation is key in bridging patients suffering from COVID-19 acute respiratory distress syndrome (ARDS) to recovery. However, resource and personnel limitations during pandemics complicate the implementation of lung-protective protocols. Automated ventilation modes may prove decisive in these settings enabling higher degrees of lung-protective ventilation than conventional modes. Method: Prospective study at a Swiss university hospital. Critically ill, mechanically ventilated COVID-19 ARDS patients were allocated, by study-blinded coordinating staff, to either closed-loop or conventional mechanical ventilation, based on mechanical ventilator availability. Primary outcome was the overall achieved percentage of lung-protective ventilation in closed-loop versus conventional mechanical ventilation, assessed minute-by-minute, during the initial 7 days and overall mechanical ventilation time. Lung-protective ventilation was defined as the combined target of tidal volume <8 ml per kg of ideal body weight, dynamic driving pressure <15 cmH2O, peak pressure <30 cmH2O, peripheral oxygen saturation ≥88% and dynamic mechanical power <17 J/min. Results: Forty COVID-19 ARDS patients, accounting for 1,048,630 minutes (728 days) of cumulative mechanical ventilation, allocated to either closed-loop (n = 23) or conventional ventilation (n = 17), presenting with a median paO2/ FiO2 ratio of 92 [72-147] mmHg and a static compliance of 18 [11-25] ml/cmH2O, were mechanically ventilated for 11 [4-25] days and had a 28-day mortality rate of 20%. During the initial 7 days of mechanical ventilation, patients in the closed-loop group were ventilated lung-protectively for 65% of the time versus 38% in the conventional group (Odds Ratio, 1.79; 95% CI, 1.76-1.82; P < 0.001) and for 45% versus 33% of overall mechanical ventilation time (Odds Ratio, 1.22; 95% CI, 1.21-1.23; P < 0.001). Conclusion: Among critically ill, mechanically ventilated COVID-19 ARDS patients during an early highpoint of the pandemic, mechanical ventilation using a closed-loop mode was associated with a higher degree of lung-protective ventilation than was conventional mechanical ventilation.

scholarly journals Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Gaetano Scaramuzzo ◽  
◽  
Lorenzo Gamberini ◽  
Tommaso Tonetti ◽  
Gianluca Zani ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Lung Ventilation ◽  
Clinical History ◽  
Complication Rates ◽  
Prone Positioning ◽  
Mechanically Ventilated ◽  
Physiological Variables ◽  
Icu Length Of Stay ◽  
Severity Scores

Abstract Background Prone positioning (PP) has been used to improve oxygenation in patients affected by the SARS-CoV-2 disease (COVID-19). Several mechanisms, including lung recruitment and better lung ventilation/perfusion matching, make a relevant rational for using PP. However, not all patients maintain the oxygenation improvement after returning to supine position. Nevertheless, no evidence exists that a sustained oxygenation response after PP is associated to outcome in mechanically ventilated COVID-19 patients. We analyzed data from 191 patients affected by COVID-19-related acute respiratory distress syndrome undergoing PP for clinical reasons. Clinical history, severity scores and respiratory mechanics were analyzed. Patients were classified as responders (≥ median PaO2/FiO2 variation) or non-responders (< median PaO2/FiO2 variation) based on the PaO2/FiO2 percentage change between pre-proning and 1 to 3 h after re-supination in the first prone positioning session. Differences among the groups in physiological variables, complication rates and outcome were evaluated. A competing risk regression analysis was conducted to evaluate if PaO2/FiO2 response after the first pronation cycle was associated to liberation from mechanical ventilation. Results The median PaO2/FiO2 variation after the first PP cycle was 49 [19–100%] and no differences were found in demographics, comorbidities, ventilatory treatment and PaO2/FiO2 before PP between responders (96/191) and non-responders (95/191). Despite no differences in ICU length of stay, non-responders had a higher rate of tracheostomy (70.5% vs 47.9, P = 0.008) and mortality (53.7% vs 33.3%, P = 0.006), as compared to responders. Moreover, oxygenation response after the first PP was independently associated to liberation from mechanical ventilation at 28 days and was increasingly higher being higher the oxygenation response to PP. Conclusions Sustained oxygenation improvement after first PP session is independently associated to improved survival and reduced duration of mechanical ventilation in critically ill COVID-19 patients.

scholarly journals Red cell distribution width as a prognostic marker in mechanically ventilated children admitted in pediatric critical care unit of tertiary care centre, India

2018 ◽  
Vol 5 (5) ◽  
pp. 1794
Author(s):  
Swati M. Gadappa ◽  
Manas Kumar Behera
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Critically Ill ◽  
Red Cell Distribution Width ◽  
Critically Ill Children ◽  
Red Cell ◽  
Cell Distribution ◽  
Distribution Width ◽  
Mechanically Ventilated ◽  
Prospective Longitudinal

Background: Paediatric population is a vulnerable group necessitating standard care for medically and surgically ill children. Red cell distribution width (RDW) is a simple and low-cost measure that denotes the variability in red blood cell size. Any process that releases reticulocytes in the circulation will result in an increase in RDW. RDW may also be useful as a biomarker of disease severity and clinical outcomes in critically ill patients. Methods: Retrospective cohort study of all patients between 1month-12yrs of age, mechanically ventilated in Paediatric intensive care unit. Those patients with RDW on admission and complete data for PIM3 (Paediatric Index of Mortality 3) were included. Analyses included correlation, logistic regression analysis, and receiver operating characteristic (ROC) curves.Results: Retrospective analysis of data on 93 consecutive critically ill children admitted in PICU was done between Jan 2015- June 2016. We noted statistically significant correlation between mortality and anemia (10.24 g/dL, SD 2.26; 8.78 g/dL, SD 2.60.p = 0.009), LOS on MV (p = 0.008), RDW (p = 0.002), shock (p = 0.004) and ventilator associated Pneumonia (p = 0.024).  Mortality increased as length of stay on mechanical ventilation increased (4.13 days, SD 2.125 versus 6.94 days, SD 7.603 p = 0.008). The cut-off of 18.10 was chosen as Mean RDW. Based on AUROC, RDW is independently associated with high risk of mortality.Conclusions: RDW measured within 24 hours of PICU admission was independently associated with length of stay on mechanical ventilation and mortality in a general PICU population. We recommend the need for multicentric, prospective longitudinal studies to determine the optimum utility of RDW to enhance decision making in PICU.

scholarly journals Non-cardio respiratory monitoring of mechanically ventilated critically ill patients

2019 ◽  
pp. S150-S159
Author(s):  
Chinmaya Kumar Panda ◽  
Habib Mohammad Reazaul Karim ◽  
Subrata Kumar Singha
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Well Being ◽  
Multiple Organ ◽  
Respiratory Monitoring ◽  
Arterial Oxygen ◽  
Mechanically Ventilated

Critically ill patients often require multiple organ supports; respiratory support in terms of mechanical ventilation (MV) is one of the commonest. But, only providing an organ support contributes less to the complete well being of the patients. Moreover, MV itself can affect various physiological systems, metabolic response, and cause side effects. A very close temporal relationship exists between patients, monitoring and management decision too, and therefore, appropriate information from monitoring can lead to better outcomes. The present review is intended to briefly highlight the current opinions and strategies for non cardio-respiratory monitoring in such critically ill patients.Abbreviations: AKI-Acute Kidney Injury; APACHE-Acute Physiology and Chronic Health Evaluation; BPS-Behavioral Pain Scale; CAM-ICU-Confusion Assessment Method for the Intensive Care Unit; CPOT–Critical Care Pain Observation Tool; EVLWI-Extra vascular lung water index; FDA-Food and Drug Administration; ISO-International Organization for Standardization; ICU-Intensive Care Unit; LOS-Length of stay; MODS-Multiple Organ Dysfunction Score; MV-Mechanical Ventilation; PaO2-Partial pressure of arterial oxygen; FiO2-Fraction of inspired oxygen; SAPS-Simplified Acute Physiologic Score; RASS-Richmond Agitation Sedation Scale; SOFA-Sequential Organ Failure Assessment; SAS-Sedation Agitation Scale; UO-Urine outputCitation: Panda CK, Karim HMR, Singha SK. Non-cardio respiratory monitoring of mechanically ventilated critically ill patients. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S150-S159Received: 9 Jul 2018 Reviewed: 1 Oct 2018 Corrected & Accepted: 9 Oct 2018

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