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Pulmonary Critical Care and Mechanical Ventilation

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Geriatric Trauma and Critical Care
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Abstract

Aging has a negative impact on all organ systems in the body. Age-related diminution in reserve is felt on the respiratory system the earliest [1], and trauma to the chest has a disproportionate influence on outcomes following injury at all ages [2]. In addition to this direct impact chest trauma has on outcomes, even in the absence of direct chest injury, adequate oxygenation is critical to healing of all injured tissues/organs with the injured brain being at greatest risk of even brief periods of hypoxemia during the immediate post-injury period. For these reasons adequate pulmonary care following injury is critically important not only from the respiratory standpoint but also for overall recovery.

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References

  1. Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging. 2006;1:253–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Peterson RJ, Tepas 3rd JJ, Edwards FH, et al. Pediatric and adult thoracic trauma: age-related impact on presentation and outcome. Ann Thorac Surg. 1994;58:14–8.

    Article  CAS  PubMed  Google Scholar 

  3. Richter T, Ragaller M. Ventilation in chest trauma. J Emerg Trauma Shock. 2011;4:251–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Crapo RO. The aging lung. In: Mahler DA, editor. Pulmonary disease in the elderly patient. New York: Marcel Dekker; 1993. p. 1–21.

    Google Scholar 

  5. Ware JH, Dockery DW, Louis TA, et al. Longitudinal and cross-sectional estimates of pulmonary function decline in never-smoking adults. Am J Epidemiol. 1990;132:685–700.

    Article  CAS  PubMed  Google Scholar 

  6. Turner JM, Mead J, Wohl ME. Elasticity of human lungs in relation to age. J Appl Physiol. 1968;25:664–71.

    Article  CAS  PubMed  Google Scholar 

  7. Freye E, Levy JV. Use of opioids in the elderly – pharmacokinetic and pharmacodynamics considerations. Anasthesiol Intensivmed Notfallmed Schmerzther. 2004;39:527–37.

    Article  CAS  PubMed  Google Scholar 

  8. Francis Jr J. Surgery in the elderly. In: Goldman DR, Brown F, Guarneri DM, editors. Peri-operative medicine. 2nd ed. New York: McGraw-Hill, Inc.; 1994. p. 385–94.

    Google Scholar 

  9. Hall WJ, Ahmed B. Pulmonary disorders. In: Duthie Jr EH, Katz PR, Malone ML, editors. Duthie: practice of geriatrics. 4th ed. Philadelphia: Saunders; 2007. p. 536–76.

    Google Scholar 

  10. Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999;354:1851–8.

    Article  CAS  PubMed  Google Scholar 

  11. How-to Guide. Prevent ventilator-associated pneumonia. Cambridge: Institute for Healthcare Improvement; 2012.

    Google Scholar 

  12. Niel-Weise BS, Gastmeier P, Kola A, et al. An evidence-based recommendation on bed head elevation for mechanically ventilated patients. Crit Care. 2011;15:R111. doi:10.1186/cc10135.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Berman A et al. Kozier & Erb’s fundamentals of nursing: concepts, process, and practice. Boston: Pearson Education, Inc.; 2012.

    Google Scholar 

  14. Lawrence VA et al. Strategies to reduce postoperative pulmonary complications after non cardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144:596–608.

    Article  PubMed  Google Scholar 

  15. Pelus S, Kaplan D. What the new guidelines offer for pre-operative risk reduction. Patient Care. 2006;40(10):18–25.

    Google Scholar 

  16. Westwood K et al. Incentive spirometry decreases respiratory complications following major abdominal surgery. Surgeon. 2007;5:339–42.

    Article  CAS  PubMed  Google Scholar 

  17. Ullman DA, Fortune JB, Greenhouse BB, et al. The treatment of patients with multiple rib fractures using continuous thoracic epidural narcotic infusion. Reg Anesth. 1989;14:43–7.

    CAS  PubMed  Google Scholar 

  18. Allen GS, Coates NE. Pulmonary contusion: a collective review. Am Surg. 1996;62(11):895–900. PMID 8895709

    CAS  PubMed  Google Scholar 

  19. Michaels AJ. Management of post traumatic respiratory failure. Crit Care Clin. 2004;20(1):83–99. vi–vii

    Article  PubMed  Google Scholar 

  20. Torres A, Serra-Batlles J, Ros E, et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med. 1992;116:540–3.

    Article  CAS  PubMed  Google Scholar 

  21. Orozco-Levi M, Torres A, Ferrer M, et al. Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med. 1995;152:1387–90.

    Article  CAS  PubMed  Google Scholar 

  22. Rodriguez JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM. Early tracheostomy for primary airway management in the surgical critical care setting. Surgery. 1990;108:655–9.

    CAS  PubMed  Google Scholar 

  23. Hansen TS, Larsen K, Engberg AW. The association of functional oral intake and pneumonia in patients with severe traumatic brain injury. Arch Phys Med Rehabil. 2008;89:2114–20.

    Article  PubMed  Google Scholar 

  24. Hollingsed TC, Saffle JR, Barton RG, Craft WB, Morris SE. Etiology and consequences of respiratory failure in thermally injured patients. Am J Surg. 1993;166(6):592–6. ; discussion 596–7

    Article  CAS  PubMed  Google Scholar 

  25. Kostadima E, Kaditis AG, Alexopoulos EI, Zakynthinos E, Sfyras D. Early gastrostomy reduces the rate of ventilator-associated pneumonia in stroke or head injury patients. Eur Respir J. 2005;26:106–11.

    Article  CAS  PubMed  Google Scholar 

  26. Metheny NA, Clouse RE, Clark JM, Reed L, Wehrle MA, Wiersema L. pH testing of feeding-tube aspirates to determine placement. Nutr Clin Pract. 1994;9(5):185–90.

    Article  CAS  PubMed  Google Scholar 

  27. Bankhead R, Boullata J, Brantley S, et al. Enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr. 2009;33(2):122–67.

    Article  PubMed  Google Scholar 

  28. Metheny NA, Schallom L, Oliver DA, Clouse RE. Gastric residual volume and aspiration in critically ill patients receiving gastric feedings. Am J Crit Care. 2008;17(5):512–9.

    PubMed  PubMed Central  Google Scholar 

  29. Pinilla JC, Samphire J, Arnold C, Liu L, Thiessen B. Comparison of gastrointestinal tolerance to two feeding protocols in critically ill patients: a prospective, randomized controlled trial. JPEN J Parenter Enteral Nutr. 2001;25(2):81–6.

    Article  CAS  PubMed  Google Scholar 

  30. McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009;33(3):277–316.

    Article  PubMed  Google Scholar 

  31. Torres A, El-Ebiary M, Riquelme R, et al. Community-acquired pneumonia in the elderly. Semin Respir Infect. 1999;14:173–83.

    CAS  PubMed  Google Scholar 

  32. Centers for Disease Control and Prevention (CDC), USA. Pneumonia and influenza death rates, United States 1979–1994. MMWR. 1995;44:535–7.

    Google Scholar 

  33. Hamilton VA, Grap MJ. The role of the endotracheal tube cuff in microaspiration. Heart Lung. 2012;41(2):167–72.

    Article  PubMed  Google Scholar 

  34. Doebbeling BN, Stanley GL, Sheetz CT, et al. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in in- tensive care units. N Engl J Med. 1992;327:88–93.

    Article  CAS  PubMed  Google Scholar 

  35. Herzig S, Howell MD, Ngo LH, Marcantonio ER. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA. 2009;301(20):2120–8.

    Article  CAS  PubMed  Google Scholar 

  36. Scannapieco FA, Yu J, Raghavendran K, Vacanti A, Owens SI, Wood K, Mylotte JM. A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients. Crit Care. 2009;13(4):R117. Epub 2009 Jul 15

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mahul P, Auboyer C, Jospe R, Ros A, Guerin C, el Khouri Z, et al. Prevention of nosocomial pneumonia in intubated patients: respective role of mechanical subglottic secretions drainage and stress ulcer prophylaxis. Intensive Care Med. 1992;18:20–5.

    Article  CAS  PubMed  Google Scholar 

  38. Valles J, Artigas A, Rello J, Bonsoms N, Fontanals D, Blanch L, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med. 1995;122:179–86.

    Article  CAS  PubMed  Google Scholar 

  39. Kollef MH, Skubas NJ, Sundt TM. A randomized clinical trial of continuous aspiration of subglottic secretions in cardiac surgery patients. Chest. 1999;116:1339–46.

    Article  CAS  PubMed  Google Scholar 

  40. Kollef MH, Afessa B, Anzueto A, Veremakis C, Kerr KM, Margolis BD, et al. Silver-coated endotracheal tubes and the inceidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA. 2008;300:805–13.

    Article  CAS  PubMed  Google Scholar 

  41. Million LC. Getting started kit: prevent ventilator-associated pneumonia how-to guide. Cambridge: Institute for Healthcare Improvement; 2008.

    Google Scholar 

  42. Ranji SR, Auerbach AD, Hurd CJ, O'Rourke K, Shojania KG. Effects of rapid response systems on clinical outcomes: systematic review and meta-analysis. J Hosp Med. 2007;2(6):422–32.

    Article  PubMed  Google Scholar 

  43. Brown SD, Walters MR. Patients with rib fractures: use of incentive spirometry volumes to guide care. J Trauma Nurs. 2012;19(2):89–91.

    Article  PubMed  Google Scholar 

  44. Meyer KC. Lung infections and aging. Ageing Res Rev. 2004;3(1):55–67.

    Article  PubMed  Google Scholar 

  45. American Thoracic Society and the Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.

    Article  Google Scholar 

  46. Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122(1):262–8.

    Article  PubMed  Google Scholar 

  47. Riaz OJ et al. Bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia: to quantitate or not, that is the question. Am Surg. 2011;77(3):297–303.

    PubMed  Google Scholar 

  48. Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, WWermert D, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290:2588–98.

    Article  CAS  PubMed  Google Scholar 

  49. Malhotra AK, Riaz OJ, Duane TM, Aboutanos MB, Goldberg AE, Smalara KM, et al. Subthreshold quantitative bronchoalveolar lavage: clinical and therapeutic implications. J Trauma. 2008;65:580–8.

    Article  PubMed  Google Scholar 

  50. Webb HH, Tierney DF. Experimental pulmonary edema due to intermitant positive pressure ventilation with high inflation pressures. Protection by positive end-expiratory pressure. Am Rev Respir Dis. 1974;110:556–65.

    CAS  PubMed  Google Scholar 

  51. Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis. 1988;137:1159–64.

    Article  CAS  PubMed  Google Scholar 

  52. Bitterman H. Bench-to-bedside review: Oxygen as a drug. Crit Care. 2009;13(1):205.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Yang KL, Tobin MJ. Abprospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991;324:1445–50.

    Article  CAS  PubMed  Google Scholar 

  54. Breitenbucher A, Ershowsky P, Krieger B. Rapid, shallow breathing is a predictor of weaning outcome in elderly [abstract]. Am Rev Respir Dis. 1992;145(pt 2):A520.

    Google Scholar 

  55. Krieger BP, Isber J, Breitenbucher A, Throop G, Ershowsky P. Serial measurements of the rapid-shallow-breathing index as a predictor of weaning outcome in elderly medical patients. Chest. 1997;112:1029–34.

    Article  CAS  PubMed  Google Scholar 

  56. Ranes JL, Gordon SM, Chen P, Fatica C, Hammel J, Gonzales JP, et al. Predictors of long-term mortality in patients with ventilator-associated pneumonia. Am J Med. 2006;119(10):819.

    Article  Google Scholar 

  57. Holzapfel L, Chevret S, Madinier G, Ohen F, Demingeon G, Coupry A, et al. Influence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial. Crit Care Med. 1993;21(8):1132–8.

    Article  CAS  PubMed  Google Scholar 

  58. Devarajan J, Vydyanathan A, Xu M, Murthy SM, McCurry KR, Sessler DI, Sabik J. Bashour CAEarly tracheostomy is associated with improved outcomes in patients who require prolonged mechanical ventilation after cardiac surgery. J Am Coll Surg. 2012;214(6):1008–16.e4.

    Article  PubMed  Google Scholar 

  59. Gomes Silva BN, Andriolo RB, Saconato H, Atallah AN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev. 2012;(3):CD007271.

    Google Scholar 

  60. Cavaliere S, Bezzi M, Toninelli C, Foccoli P. Management of post-intubation tracheal stenoses using the endoscopic approach. Monaldi Arch Chest Dis. 2007;67(2):73–80.

    CAS  PubMed  Google Scholar 

  61. Meinders AJ, Van Der Hoeven JG, Meinders AE. The outcome of prolonged mechanical ventilation in elderly patients: are the efforts worthwhile? Age Ageing. 1996;25:353–6.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Ajai K. Malhotra MD, FACS .

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Malhotra, A.K. (2017). Pulmonary Critical Care and Mechanical Ventilation. In: Luchette, F., Yelon, J. (eds) Geriatric Trauma and Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-48687-1_36

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  • DOI: https://doi.org/10.1007/978-3-319-48687-1_36

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