Complications and Pharmacologic Interventions of Invasive PositivePressure Ventilation During Critical Illness

摘要

>Objective: To review the fundamentals of invasive positive pressure ventilation (IPPV) and the common complications and associated pharmacotherapeutic management in order to provide opportunities for pharmacists to improve patient outcomes. >Data Sources: A MEDLINE literature search (1950-December 2017) was performed using the key search terms invasive positive pressure ventilation, mechanical ventilation, pharmacist, respiratory failure, ventilator associated organ dysfunction, ventilator associated pneumonia, ventilator bundles, and ventilator liberation. Additional references were identified from a review of literature citations. >Study Selection and Data Extraction: All English-language original research and review reports were evaluated. >Data Synthesis: IPPV is a common supportive care measure for critically ill patients. While lifesaving, IPPV is associated with significant complications including ventilator-associated pneumonia, sinusitis, organ dysfunction, and hemodynamic alterations. Optimization of pain and sedation management provides an opportunity for pharmacists to directly affect IPPV exposure. A number of pharmacotherapeutic interventions are relateddirectly to prophylaxis against IPPV-associated adverse events or aimed atreduction of duration of IPPV. >Conclusions: Enhanced knowledge ofthe common complications, associated pharmacotherapy, and monitoring strategiesfacilitate the pharmacist’s ability to provide increased pharmacotherapeuticinsight in a multidisciplinary intensive care unit setting.