Complications
Can occur with positive pressure ventilation either with non-invasive ventilation (NIV) or with intubation (also reported with bag-valve-mask ventilation).
The endotracheal tube can be placed low into the right mainstem bronchus or become dislodged, resulting in inadvertent extubation.
Aspiration of oral secretions and vomitus can occur with non-invasive (positive pressure) ventilation (NIV), resulting in nosocomial pulmonary infection. During intubation, aspiration may occur despite the upper airways being sealed by the endotracheal tube (in young children) and endotracheal tube balloon, meaning that delayed pneumonia and possible lung abscess may occur in patients who have been intubated.[87][88]
There is evidence to suggest that clearing secretions by sub-glottic suctioning can reduce the risk of pulmonary infection in intubated patients.
Throat pain secondary to intubation may occur and requires analgesic use.
Patients who have been managed with CPAP or BiPAP may develop sinus and middle ear infection in the week following recovery.
During the process of endotracheal intubation, teeth may be accidentally damaged or dislodged. The process of intubation may also be complicated by soft tissue tears and haematomas of the lips and oral-pharyngeal cavities.
Prolonged use of endotracheal tubes (>72 hours) or over-inflation of endotracheal tube sealing balloons may lead to tracheal inflammation in the week following recovery and potentially chronic stenosis.
The tight-fitting mask seal used for CPAP and BiPAP may cause localised skin ulceration or necrosis at the points of contact. The bridge of the nose is particularly at risk. Skin and soft tissue damage is usually obvious when the mask is removed; however, necrosis may occur in the week following recovery.
Oxygen delivery by cannula can dry and damage nasal mucosa, resulting in irritation and superficial infection, raising the risk for colonisation with methicillin-resistant Staphylococcus aureus.
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