Mechanical ventilation

Method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a registered nurse, physician, respiratory therapist, paramedic, or other suitable person compressing a bag or set of bellows. There are two main divisions of mechanical ventilation: invasive ventilation and non-invasive ventilation.

There are two main modes of mechanical ventilation within the two divisions: positive pressure ventilation, where air (or another gas mix) is pushed into the trachea, and negative pressure ventilation, where air is, in essence, sucked into the lungs.

Among a nationally representative sample of hospitalizations, nearly one-in-six patients had prolonged mechanical ventilation after EVT. Heart failure and diabetes were significantly associated with prolonged mechanical ventilation following endovascular treatment (EVT). Prolonged ventilation was associated with a significant increase in in-hospital mortality and morbidity 1).

Prolonged fever is the common complication in neurosurgical patients. The risks of prolonged fever in patients are attributed to antibiotic therapy, use of central venous catheter and prolonged mechanical ventilation. Indicators of prolonged fever are helpful for better identification of high-risk patients and fever control 2).

Reusser et al. studied prospectively 40 critically ill neurosurgical patients who required prolonged mechanical ventilation to determine the current incidence of stress-related gastroduodenal erosions and ulcers, and to assess endoscopically the efficacy of acid-reducing prophylactic treatment. Nineteen patients were randomized to receive ranitidine plus antacids if necessary to maintain gastric pH at greater than or equal to 4. The remaining 21 patients were given no drug prophylaxis. Gastric pH was significantly (p less than .001) higher in the treated group: 78% of pH readings were at greater than or equal to 4 as compared to 32% in the control group. However, after five study days, incidence and severity of stress lesions were similar in the two groups: nine patients in each group had more than five erosions, one treated patient had a gastric ulcer, and one control patient had duodenal ulcerations. No patient experienced clinically relevant upper GI bleeding. The lack of severe stress bleeding and the low ulcer rate contrast with results from earlier reports on similar patient populations. Furthermore, drug prophylaxis had no detectable benefit, as assessed endoscopically. These findings suggest that routine stress lesion prophylaxis may not be necessary in critically ill patients with comparable risk factors 3).

Saber H, Palla M, Kazemlou S, Navi BB, Yoo AJ, Simonsen CZ, Sandio A, Rajah G, Khatibi K, Liebeskind DS, Sheth SA. Prevalence, Predictors, and Outcomes of Prolonged Mechanical Ventilation After Endovascular Stroke Therapy. Neurocrit Care. 2020 Oct 21. doi: 10.1007/s12028-020-01125-9. Epub ahead of print. PMID: 33089433.
Wang Z, Shen M, Qiao M, Zhang H, Tang Z. Clinical factors and incidence of prolonged fever in neurosurgical patients. J Clin Nurs. 2016 May 30. doi: 10.1111/jocn.13409. [Epub ahead of print] PubMed PMID: 27240113.
Reusser P, Gyr K, Scheidegger D, Buchmann B, Buser M, Zimmerli W. Prospective endoscopic study of stress erosions and ulcers in critically ill neurosurgical patients: current incidence and effect of acid-reducing prophylaxis. Crit Care Med. 1990 Mar;18(3):270-4. PubMed PMID: 2302950.
  • mechanical_ventilation.txt
  • Last modified: 2020/10/22 21:41
  • by administrador