Mechanical Ventilation

When a patient cannot breathe on his/her own it is often necessary to use a “breathing machine” or ventilator.  Although the ventilator will support the patient’s life, it is at times associated with complications.  The following list reflects some of the known complications associated with mechanical ventilation. 

• upper airway and nasal trauma
• chipped teeth
• laceration in the back of the throat
• ventilator-associated pneumonia (VAP) 
• Barotrauma/Pneumothorax (air in the chest)

The above mentioned complications are known to happen at varying frequency during urgent endotracheal tube placement.

• It is however the failure to intubate in a timely fashion that can be considered deviation from the standard of care rather than the complications arising from the intubation. 

• It is the physician’s responsibility to verify that the endotracheal tube is in the correct position, thus the standard of care requires that a chest x-ray be obtained, and oxygenation of the patient verified.   Failure to follow these guidelines may result in severe complications, such as brain injury, and death. 

• When patients are on mechanical ventilation, air is pushed into their lungs under pressure.  This pressure can be adjusted in such a way to accommodate their needs for oxygen.  The pressure however may result in a rupture of an alveolus (small part of the lung) with subsequent entry of air into the pleural space (pneumothorax).  This is known as barotrauma.  The failure to diagnose and treat pneumothorax in a timely manner could be considered a deviation from the standard of care.