In times of emergency, artificial ventilation is a life saver. It is a procedure in which a doctor puts a tube, called an endotracheal tube, down a patient's windpipe and connects him to a ventilator. This machine then delivers breaths to him and keeps him alive. Although this is of great help to the patient, it can also be detrimental in the long term. There are side effects to having the tube in too long and letting the machine breathe for the patient. The risk must be balanced against the need.
The prolonged use of an endotracheal tube can cause long-term damage to the vocal cords and the surrounding tissue of the throat and lungs. Necrosis, or the tissue death, of parts of the trachea can occur when the tube is kept in for too long. The trachea can also narrow, which is known as stenosis. Sinusitis is another side effect of having the tube in for a long period. Swelling of the tissues of the throat are also common.
There are two types of lung injury caused by artificial ventilation that can have long-term effects. One type of injury is barotrauma. This is when an alveolus, or air sac in the lung, ruptures and allows air to enter into the chest cavity. It causes pneumothorax and is a life threatening situation that must be treated with a chest tube. Another type of injury is volutrauma. This is an over-inflation of the alveoli that causes an inflammation response in the lungs. It can cause the lung tissue to become damaged and unable to be used for normal breathing.
Ventilator Associated Pneumonia
Patients who contract ventilator-associated pneumonia may have many long-term effects. According to Medscape, there is a 33 to 50 percent mortality rate from this complication. It is a pneumonia brought about by the introduction of the endotracheal tube into the lungs. The infections usually occurs 48 hours after initial intubation, but the long-term effects can be devastating. It takes a long course of antibiotics to treat and must be pursued aggressively.
Intrinsic Positive End Expiratory Pressure (PEEP)
The complication of intrinsic positive end expiratory pressure, or PEEP, is common in patients who have trouble exhaling the entire amount of their lung capacity. Patients that have chronic obstructive pulmonary disease and asthma would fit this profile. The machine would keep delivering breaths that would not get exhaled fully, and this could lead to barotrauma, volutrama, hypotension, ventilator dyssynchrony or death. Clinicians need to be aware of patients that would be at risk for this side effect.
Artificial ventilation can have effects on the body as a whole that only get worse the longer the patient is ventilated. The gastrointestinal system slows down from sedation and may cause a total stoppage of the intestines, or illeus. Edema, or fluid retention, can occur due to reduced blood flow to the kidneys. The amount of blood the heart is able to eject, or cardiac output, is also negatively affected by positive ventilation pressures. Delirium and agitation can be seen in patients as well because the blood flow to the brain is affected by the ventilator.