Page 265 - Clinical Application of Mechanical Ventilation

Initiation of Mechanical Ventilation 231

Types of Hazards and Complications

Prospective studies of patient outcome during mechanical ventilation indicate
that hazards and complications are related to (1) positive pressure ventilation (e.g.,
barotrauma, impedance of cardiac output), (2) patient condition (e.g., organ fail-
ure), (3) ventilator and artificial airway (accidental extubation), and (4) medical
professionals (e.g., nosocomial infection). Examples for each of these four areas are
shown in Table 8-13.

TABLE 8-13 Hazards and Complications of Mechanical Ventilation

Condition Examples
Related to positive pressure Barotrauma (pneumothorax,
ventilation mediastinal air leak, subcutaneous air
leak)
Hypotension, decrease in cardiac
output
Arrhythmia
Oxygen toxicity
Bronchopleural fistula
Bronchopulmonary dysplasia (in infants)
Upper gastrointestinal hemorrhage

Related to patient condition Infection (due to reduced immunity)
Physical and psychologic trauma
Multiple organ failure (may be
preexisting)
Related to equipment Ventilator and alarm malfunction
(ventilator and Ventilator circuit disconnection
artificial airway) Accidental extubation
Main bronchus intubation
Postintubation stridor
Endotracheal tube blockage
Tissue damage
Atelectasis (due to inadequate tidal
volume)

Related to medical Nosocomial pneumonia (due to
professionals cross-contamination)
Inappropriate ventilator settings
Misadventures (due to lapses of
understanding and
communication)

(Data from Ventilator alarm failures, Bourke et al., 1987; Milligan, 1992; Pryn et al., 1989; Slee et al., 1988; and Other
hazards and complications: Bezzant et al., 1994; Cox et al., 1991; Liu et al., 1991; Pierson, 1990; Rivera et al., 1992.)
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