Basic Invasive Mechanical Ventilation

Benjamin D. Singer, MD; Thomas C. Corbridge, MD

Disclosures

South Med J. 2009;102(12):1238-1245. 

In This Article

Complications of Intubation and Mechanical Ventilation

Numerous complications of intubation and mechanical ventilation may arise. Toxic effects of lung over-inflation (volutrauma) include pneumothorax and acute lung injury. Volutrauma is minimized by adjusting the ventilator settings-particularly VT and PEEP-to keep Pplat less than 30 cm H2O. Oxygen toxicity is proportional to the duration of time that the patient is exposed to FiO2 greater than 0.6. Cardiac output may be increased or decreased based on the preload- and afterload-reducing effects of positive pressure ventilation.

Ventilator-associated pneumonia (VAP) develops at a rate of approximately 1% per day and has an attributable mortality rate as high as 20–50%.[23] Hand washing, elevation of the head of the bed, non-nasal intubation, and proper nutrition all reduce the rate of VAP. Avoidance of unnecessary antibiotics decreases the risk of VAP with a resistant pathogen.

Complications from the endotracheal tube itself include hard and soft palate injuries, laryngeal dysfunction, tracheal stenosis, tracheomalacia, and near-fatal or fatal obstruction.

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