Although mechanical ventilation (MV) of critically ill patients may be life saving, complications associated with MV occur commonly. In this prospective study, we investigated the complications of the MV including injuries to the airway due to intubations and/or tracheostomy, self-extubation, nosocomial pneumonia (NP), and barotrauma. Furthermore, we noted the duration of MV and prognosis of the patients with and without NP.
Materials and methods
Fifty-five patients who required MV for more than 48 hours in our ICU during a 6 month period were included in the study. Patients who had pneumonic infiltration at admission and/or underwent ventilatory therapy in other hospitals were excluded from the study. The patients were daily evaluated in terms of the complications of MV. Age, Glasgow Coma Scala (GCS) score, APACHE II score, risk factors, duration of MV and prognosis of the patients were recorded daily. The nurse-to-patient ratio was 1:4 in our ICU.
The average age, GCS score, APACHE II score, and MV duration were 47.2 ± 20.9 years, 8.2 ± 4.1, 17.8 ± 5.7 and 15.0 ± 11.2 days, respectively. In 23 patients (41.8%) NP was diagnosed, and the NP/ventilation day ratio was 23/836 (27.5/1000). The mean MV duration in patients with or without NP was 20.4 ± 12.8 and 11.2 ± 8.1 days, respectively (P < 0.05). The mortality rate was 34.8% in the pneumonia group and 18.8% in the nonpneumonia group (P > 0.05). Barotrauma related to MV (pneumomediastinum and subcutaneus amphisema) was observed in two patients, and the other complications including larengeal edema, cuff leak, self-extubation and right main bronchial intubation were seen in 13 patients.
The incidence of NP and other complications determined in this study was comparable with previous studies reported in the literature . The mortality rate of the patients with NP was found to be higher than the patients without NP, but the difference was not statistically significant. The duration of MV in the pneumonia group was significantly higher than the nonpneumonia group.
Am Rev Respir Dis. 1990, 142:523-528. PubMed Abstract