The Analysis Of The Complications And The Etiology In Prolonged Mechanical Ventilation With Different Artificial Airways

ObjectiveTo explore the Etiology for prolonged mechanical ventilation (PMV), compare the complications, hospital mortality and survival time with different artificial airway in patients undergoing prolonged mechanical ventilation, analysis the causes and prevention of major complications of the two groups, explore the rational and effective selection and management of artificial airway.MethodsThis was a retrospective observational study of125patients who received prolonged mechanical ventilation in our ICU between March2007and March2012. Explore the etiology of PMV. According to the artificial airway,125patients were divided into two groups:the nasotracheal tubated group(76patients) And the tracheostomized group(49patients), complications, hospital mortality and survival time were compared between the two groups.Results1.There were no difference between the two groups in gender, age, respiratory failure type, acute physiology and chronic health status score (APACHE II score).2.Lung diseases(56.80%)were the main reason for patients undergoing prolonged mechanical ventilation. Meanwhile, other reasons such as neuromuscular diseases(9.60%), cerebrovascular accident(9.60%), heart disease(8.80%), multiple organ failure(8.00%), psychological factors(4.80%) and surgery(2.40%) could also lead to prolonged mechanical ventilation.3.There was significantly higher in the incidence of sinusitis in the the nasotracheal tubated group (13.15%),(χ2=4.59, P<0.05). There were no significant difference between two groups in the incidence of other complications:ventilator-associated pneumonia(VAP)32.89%vs28.57%, χ2=026, P=0.61; tracheoesophageal fistula(TEF)2.63%vs2.04%, χ2=0.04, P=0.83; tracheal stenosis1.31%vs4.08%, χ2=0.97, P=0.32; the tracheomalacia1.31%vs6.12%, x2=2.22, P=0.14; tracheal hemorrhage1.31%vs2.04%, χ2=0.10, P0.75; casing blockage1.31%vs2.04%,χ2=0.10, P=0.75.4. In the nasotracheal tubated group,39cases were dead, the mortality rate was51.32%, the average survival time was163.37±26.16days. In the tracheostomized group,15cases were dead, the mortality rate was30.61%, the average survival time was378.79±97.80days, P<0.05, there was a significant difference between the two groups.Conclusions1.Lung diseases were the main reason for patients who required prolonged mechanical ventilation, Neuromuscular diseases, cerebrovascular accident, heart diseases, multiple organ failure, surgery and psychological factors also occuped a certain proportion.2.Compared with patients in tracheostomized group, there was a higher incidence of sinusitis in the nasotracheal tubated group; there were no difference between VAP, tracheoesophageal fistula, tracheal stenosis, tracheomalacia, tracheal hemorrhage, casing blockage.3. Compared with patients in nasotracheal tubated group, there was a lower hospital mortality and a longer survival time in the tracheostomized group.4. There’s a great significance in reducing the incidence of sinusitis, prolonging the survival time and reducing the hospital mortality to choose the right artificial airway for the patients undergoing prolonged mechanical ventilation.