Ventilator Associated Events

Abstract

Acute respiratory failure is a common disease with numerous complications and high mortality rate. The ventilatory support is a cornerstone in management of ARF when the conservative measures fail. The use of invasive MV sometimes is inevitable life saving step in management of advanced cases of ARF. However, being associated with numerous complications, the invasive MV should be discontinued at the earliest possible time in the course of a patient's illness. There are numerous indications for endotracheal intubation and mechanical ventilation, but in general, mechanical ventilation should be considered when there are clinical or laboratory signs that the patient cannot maintain an airway or adequate oxygenation or ventilation. The decision to initiate mechanical ventilation should be based on clinical judgment that considers the entire clinical situation and should not be delayed until the patient is in extremis. The aim of this essay is to highlight on the incidence, possible hazards, how to treat and methods to prevent complications of mechanical ventilation.  Summary   126  The Centers for Disease Control and Prevention (CDC) has been working in conjunction with Critical Care Societies Collaborative and other professional groups to develop a new approach to Ventilator-associated pneumonia (VAP) surveillance. The result is an algorithm based on objective criterion for the diagnosis of ventilator-associated events (VAE), that is, ventilator-associated conditions (VAC) and infection-related ventilator-associated complications (IVAC), instead of VAP episodes. This new approach was scheduled to replace the VAP classical definition in 2013 in the CDC network surveillance. The VAE definition algorithm is for use in surveillance; it is not a clinical definition algorithm and is not intended for use in the clinical management of patients. Complications of mechanical ventilation can be divided into those resulting from endotracheal intubation, from mechanical ventilation itself, or from prolonged immobility and inability to eat normally. Mechanical ventilation is often carries potential complications including ventilator-associated pneumonia, ventilator induced lung injury, airway injury and alveolar damage. Other complications include decreased cardiac output, and oxygen toxicity. These complications are  Summary   127  associated with increased morbidity and mortality as well as leading to longer ventilatory support time. Potential strategies to prevent VAEs include avoiding intubation, minimizing sedation, improving performance of coordinated daily spontaneous awakening and breathing trials (SATs and SBTs), early mobility, low tidal volume ventilation, conservative fluid management, and conservative blood transfusion thresholds. These interventions were selected because randomized controlled trials suggest these strategies can decrease duration of mechanical ventilation, and in most cases, lower the incidence of one or more of the four conditions most frequently associated with VAEs (pneumonia, excess fluid, atelectasis, and/or ARDS).