Question

What are the major contributing factors to prolonged mechanical ventilation? (Multiple answer)

What are the major contributing factors to prolonged mechanical ventilation? (Multiple answer)

Homework Answers

Answer #1

Prolonged mechanical ventilation (PMV) is defined by the Centers for Medicare and Medical Services in the United States as greater than 21days of mechanical ventilation for at least six hours per day.

Provision of mechanical ventilation is indicated to improve pulmonary gas exchange and/or to reduce the work of breathing in respiratory failure.

Major contributing factors for prolonged mechanical ventilation

The duration of mechanical ventilation can be prolonged by several factors such as

  • Primary diagnosis for which the patient was transferred to ICU
  • Severity of illness and
  • Development of complications during the ICU stay
  • Admission diagnosis and acute physiology score(APS)on ICU day 1 calculated by the APACHE III scoring system,were most strongly related to the duration of mechanical ventilation
  • Among Admission diagnosis Pneumonia,ARDS,neuromuscular disease,postoperative head trauma,and postoperative intracranial hemorrhage were significantly related to the duration of mechanical ventilation.
  • Systemic factors
  • Chronic comorbid conditions (e.g.hypothroidism,malignancy,COPD,immunosuppression)
  • Overall severity of illness
  • Non-pulmonary organ failure
  • Poor nutritional status

Mechanical factors

  • Increased work of breathing
  • Reduced respiratory muscle capacity
  • Critical illness polyneuropathy,Steroid myopathy,Disuse myopathy,Isolated phrenic nerve or diaphragmatic injury (e.g. after surgery)
  • Imbalance between increased work of breathing &respiratory muscle capacity
  • Upper airway obstructions (e.g. tracheal stenosis)preventing decannulation

Latrogenic factors

  • Failure to recognize withdrawal potential
  • Inappropriate ventilator settings leading to excessive loads/discomfort
  • Imposed work of breathing from tracheostomy tubes
  • Medical errors

Complications of long term hospital care

  • Recurrent aspiration
  • Infection(e.g. pneumonia,sepsis)
  • Stress ulcer
  • Deep vein thrombosis

Psychological factors

  • Delirium
  • Depression
  • Anxiety
  • Sleep deprivation
  • Sedation

Process of care factors like a absence of weaning protocols,inadequate nursing staffing,insufficient physician experience.

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