Complications of prolonged invasive mechanical ventilation

Given that ventilation is not a consequence-free process, one might imagine that the process of being ventilated for an unnaturally long time might result in some significant lifestyle changes.

Complications of ventilation

There is a study reporting on the association between duration of ventilation and mortality. Prolonged ventilation (when defined as a ventilation time of more than 21 days) seems to be associated with a 1-year mortality of 52%. Quality of life of the survivors is also poor. However, of those surviving after 3 years roughly 99% report a return to baseline function (which probably means they were good quality protoplasm).

Othr complications of prolonged ventilation include the following:

• Mucosal ulceration due to decreased gastric blood flow
• Sleep disturbance and neuropsychiatric complications thereof
• Increased sedation requirements and neuropsychiatric complications thereof
• Ventilator-Associated Pneumonia (VAP)
• Ventilator-associated lung injury (VALI)
• Muscle wasting: specifically, of respiratory muscles (which starts to happen within 18 hours of mechanical ventilation). This, of course, creates the need for even more prolonged ventilation by frustrating our weaning efforts.
• Swallowing dysfunction (prolonged stimulation of the gag reflex)

Complications of prolonged intubation

• Laryngeal injury due to tube pressure or accidental self-extubation
• Tracheal injury due to cuff pressure and movement-related erosion
• Carina and bronchial injury due to repeated suctioning
• Laryngotracheal stenosis
• Tracheal stenosis
• Tracheomalacia (deterioration of tracheal cartilages)

Complications of prolonged tracheostomy

• Tracheal stensosis (or tracheoectasia)
• Tracheomalacia (deterioration of tracheal cartilages)
• Tracheo-innominate fistula
• Traeo-oesophageal fistula