Increased carbon dioxide levels may decrease cerebral blood flow and increase ICP as a result.Ĭerebral hypo perfusion can occur when high mean airway pressures are used during mechanical ventilation. The use of PEEP during mechanical ventilation may increase ICP by reducing central venous blood return leaving the brain. Increased intracranial pressure is common in patients with traumatic brain injury or stroke. The use of PEEP increases pressure applied to the alveoli and may compress pulmonary vasculature. Increased pulmonary vascular resistance also may result from the reduced cardiac output caused by PPV and the use of PEEP. The same affect can occur with patients who are using CPAP for sleep apnea. Hypotension and decreased cardiac output may occur when increased intra-thoracic pressure from positive pressure ventilation and PEEP use decreases venous blood returning to the right atrium. Neonatal retinopathy is also associated with exposure of the neonate to high FiO2. This leads to an even more severe systemic inflammatory response as a result.Īlveolar damage may is associated with prolonged use of high FiO2’s for greater than 48 hours.Ībsorption atelectasis also may occur due to high fio2 use. These bio-elements cause further damage to the alveolar-capillary membrane by allowing bacteria into the bloodstream. Kuebler īiotrauma occurs when aforementioned traumas fill the alveoli with cytokines, proteins, white blood cells, and neutrophils. Photo credit: Jana Grune, Arata Tabuchi, Wolfgang M. As a result, cellular proteins leak into the extracellular fluid leading to pulmonary edema. This creates shearing forces which damage the epithelial cells of the alveoli. So, when a tidal volume is delivered to a diseased lung the healthy regions of the lung may receive the bulk of the tidal volume breath as compared to diseased non-compliant regions of the lung.Ītelectrauma occurs when collapsed alveoli are repeatedly snapped open with each breath only to then re-collapse again after exhalation. This is because air will follow the path of least resistance. Volutrauma can also occur even when the tidal volume is set appropriately. This damages the epithelial cells lining the alveoli. Volutrauma occurs when alveoli are over distended due to high tidal volume use. A tension pneumothorax is a condition in which air enters the pleural space with each breath but cannot exit. Barotrauma may become life threatening if it leads to tension pneumothorax. VILI can be the result of barotrauma, volutrauma, atelectrauma, and biotrauma.īarotrauma occurs when high ventilatory pressures rupture the small airways and alveoli. Ventilator induced lung injury (VILI) occurs when the alveoli capillary membrane is damaged during mechanical ventilation. Each of these effects can then go on to affect other organ systems such as the kidneys and brain. Positive pressure not only damages sensitive lung tissue but also may inhibit blood flow returning to the heart. Complications associated with mechanical ventilation are primarily related to the use of positive pressure applied to the lungs and the artificial airways required to provide invasive ventilation.
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