الفهرس 
Respiratory Failure
Pathophysiology of respiratory failureOnly 14 pages are availabe for public view
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Abstract
Acute respiratory failure is a common disease with
numerous complications and high mortality rate. The
ventilatory support is a cornerstone in management of ARF
when the conservative measures fail. The use of invasive
MV sometimes is inevitable life saving step in management
of advanced cases of ARF. However, being associated with
numerous complications, the invasive MV should be
discontinued at the earliest possible time in the course of a
patient’s illness.
There are numerous indications for endotracheal
intubation and mechanical ventilation, but in general,
mechanical ventilation should be considered when there are
clinical or laboratory signs that the patient cannot maintain
an airway or adequate oxygenation or ventilation. The
decision to initiate mechanical ventilation should be based
on clinical judgment that considers the entire clinical
situation and should not be delayed until the patient is in
extremis.
The aim of this essay is to highlight on the incidence,
possible hazards, how to treat and methods to prevent
complications of mechanical ventilation.The Centers for Disease Control and Prevention
(CDC) has been working in conjunction with Critical Care
Societies Collaborative and other professional groups to
develop a new approach to Ventilator-associated
pneumonia (VAP) surveillance. The result is an algorithm
based on objective criterion for the diagnosis of ventilatorassociated events (VAE), that is, ventilator-associated
conditions (VAC) and infection-related ventilatorassociated complications (IVAC), instead of VAP episodes.
This new approach was scheduled to replace the VAP
classical definition in 2013 in the CDC network
surveillance. The VAE definition algorithm is for use in
surveillance; it is not a clinical definition algorithm and is
not intended for use in the clinical management of patients.
Complications of mechanical ventilation can be
divided into those resulting from endotracheal intubation,
from mechanical ventilation itself, or from prolonged
immobility and inability to eat normally.
Mechanical ventilation is often carries potential
complications including ventilator-associated pneumonia,
ventilator induced lung injury, airway injury and alveolar
damage. Other complications include decreased cardiac
output, and oxygen toxicity. These complications are associated with increased morbidity and mortality as well
as leading to longer ventilatory support time.
Potential strategies to prevent VAEs include
avoiding intubation, minimizing sedation, improving
performance of coordinated daily spontaneous awakening
and breathing trials (SATs and SBTs), early mobility, low
tidal volume ventilation, conservative fluid management,
and conservative blood transfusion thresholds. These
interventions were selected because randomized controlled
trials suggest these strategies can decrease duration of
mechanical ventilation, and in most cases, lower the
incidence of one or more of the four conditions most
frequently associated with VAEs (pneumonia, excess fluid,
atelectasis, and/or ARDS).