Pathophysiology - Research Paper Sample

Introduction

In health status, the lung is an organ that is highlight exposed to different infections, which vary based on the causal agent. Among the many, ventilator-induced lung injury (VILI) and ventilator-associated pneumonia (VAP) are some of the problems that occur when a patient is subjected to mechanical ventilation (Modi & Mahboobi, 2020). In particular, ventilator-induced lung injury is damage that is experienced due to the adverse result of mechanical aeration, and this triggered multi-system dysfunction, which is a dangerous condition (Ding et al., 2018). Due to complexity, VILI has become a major risk, especially among patients with acute respiratory distress syndrome (Rice & Janz, 2020). The condition occurs due to the cyclic opening and failure of such atelectatic but recruitable lung units, especially in tidal ventilation (Ding et al., 2018). As such, high shear stress is encountered during the process, and this affects how the air bolus operates, which exposes an individual to VILI (Ding et al., 2018).

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On the other hand, ventilator-associated pneumonia is a lung problem that is experienced by individuals who are under mechanical ventilation breathing machines in healthcare (Tsay et al., 2016). Most of the individuals under this system are critically ill, and thus, they are in an intensive care unit (Modi & Mahboobi, 2020). Normally, VAP occurs as a result of the alteration of the lower respiratory tract and lung parenchyma by microorganisms, and this is triggered by pneumonia that arises 48 hours or more when an individual is under mechanical ventilation (Tsay et al., 2016). As such, intubation involves the linkage between the oropharynx and trachea, and this permits the oral and gastric section to cross in the lower airways (Yang et al., 2017). The report examines the pathophysiology and risk factors that are linked with ventilator-induced lung injury and ventilator-associated pneumonia and the prevention approach.

Pathophysiology of Ventilator-Induced Lung Injury

The primary mechanical determinant of VILI is the regional lung overdistention that is experienced due to issues that arise from transpulmonary pressure (Hoegl & Zwissler, 2017). Due to the issue, the lung tends to deform, affecting its volume, which is essential in the breathing mechanism (Ding et al., 2018). As such, the lung cell deformation triggers a mechanical condition that affects the ventilation process, and the condition impacts the flow of air to the body (Lentz et al., 2020). The condition may trigger a complex array of pro-inflammatory and anti-inflammatory mediators that can lead to more severe lung injuries (Ding et al., 2018). Due to the impact on ventilation, an individual tends to suffer from issues, such as organ dysfunction, and this exposes a patient to death risks.

Barotrauma

In some conditions, lung injuries may cause barotrauma. Barotrauma is profoundly experienced due to the variation in pressure between gas inside and outside the body (Hoegl & Zwissler, 2017). In this case, the damage is caused by shear forces that occur due to the expansion of the gas within the tissue (Hoegl & Zwissler, 2017). Therefore, when a patient is under mechanical ventilation, there is highly likely that they may experience an expansion of gas, which leads to pressure hydrostatic, thus causing lung injuries (Modi & Mahboobi, 2020). The issue leads to local infiltration of gas into the injured region, and this affects the circulatory system.

Mechanical lung injury is profoundly linked with the development of pulmonary inflammation. The condition is experienced as inflammatory are formed in response to mechanical injuries (Ding et al., 2018). As such, VILI triggered alveolar derecruitment and repeated end-expiratory alveolar failure, which increases the chance of inflammation (Ding et al., 2018). Metabolic acidosis and cardiovascular collapse that are experienced when a patient is suffering from mechanical lung injuries trigger a systemic inflammatory response (Yang et al., 2017). This response is characterized by the end terminal stage of VILI, and this increases the mortality rate among patients suffering from the condition (Modi & Mahboobi, 2020). In this case, lung inflammation affects the flow of air, which is a critical aspect in lowing the amount of oxygen available in the bloodstream (Rice & Janz, 2020).

The level of lung damage due to the impact of VILI profoundly affects the energy transfer. As such, the damage impacts the flow of energy from a mechanical ventilator to the respiratory system within a particular timeframe (Ding et al., 2018). When such an issue is experienced, some parts, such as alveolar units, are highly affected, and this exposes them to mechanical failure (Modi & Mahboobi, 2020). Additionally, mechanical injury lows the lung surface, and this triggers power breakdown, which reduces the amount of energy available to enhance life-supportive therapy (Ding et al., 2018). Under low airflow, a patient tends to suffer conditions that minimize energy transfer, and this exposes the lung to more danger (Lentz et al., 2020). As such, the condition increases the chances of pulmonary structure, such as endothelial cells.

In mechanical ventilation, driving pressure is the variation in the static airway at the end-inspiration and end-expiration, and it can be illustrated as the ratio of tidal volume to the respiratory system (Rice & Janz, 2020). The risk of VILI, such as overdistention, exposes a patient to an increase in driving pressure, which triggers lung inhomogeneity (Ding et al., 2018). Additionally, transpulmonary driving pressure is profoundly affected by the condition of VILI, especially if the mechanical lung damage is big (Ding et al., 2018). As such, when the driving pressure is high, a patient may develop other complications, which may hinder their survival rate (Modi & Mahboobi, 2020).

Evidence Based Ventilation Strategy

Due to the risk that occurs when dealing with patients who are suffering from evidence-based ventilation strategy, healthcare practitioners are encouraged to deploy systems, such as lung-protective strategy (Rice & Janz, 2020). When a person is linked with evidence-based ventilation strategy, they tend to experience conditions, such as severe hypoxia, which require a more aggressive ventilation approach to enhance the oxygenation process (Yang et al., 2017). As such, high tidal volumes and driving pressure are closely linked with prolonged ventilation, and this increases the mortality rate (Lentz et al., 2020). Therefore, the kind of system that healthcare practitioners deploy should focus on minimizing the evidence-to-practice gap (Modi & Mahboobi, 2020).

Normally, a lung-protective strategy has been linked with improvement when working with a patient with evidence-based ventilation (Ding et al., 2018). As such, the strategy operates by combining low tidal volume and comparatively high respiratory rate by deploying positive end-expiratory pressure in linkage to the right FiO2, and this helps in controlling atelectrauma and hypoxia in volume management approach in a patient who has evidence-based ventilation strategy (Tsay et al., 2016). Through balancing the positive end-expiratory pressure, the lungs of a patient are kept open, and this helps in controlling intratidal collapse and decollapse (Rice & Janz, 2020). The approach creates a better pulmonary operation and a higher weaning rate from the ventilator (Modi & Mahboobi, 2020). According to research, the application of lung-protective pulmonary roles improves survival rate among patients with evidence-based ventilation strategy by 28 days (Ding et al., 2018). By engaging in lower tidal volume, the system can limit airway pressure, thus controlling alveolar collapse.

Additionally, the implementation of VTE prophylaxis has been associated with performance improvement when handling patients with an evidence-based ventilation strategy (Rice & Janz, 2020). Typically, most patients with evidence-based ventilation strategies are profoundly associated with vascular thromboses, such as venous thromboembolism (VTE) (Modi & Mahboobi, 2020). Conditions such as pulmonary embolism occur when a blood clot gets lodged in a vessel in the lung, and this interferes with driving pressure and tidal volume (Tsay et al., 2016). As such, the effective application of VTE prophylaxis helps in minimizing the risks of pulmonary embolism (Rice & Janz, 2020). To enhance the effectiveness of the system, it is crucial for healthcare practitioners to engage in multidisciplinary care, which improves the performance of patients under mechanical ventilation (Lentz et al., 2020).

A close trial with nasal invasive positive pressure ventilation (NIPPV) gives healthcare practitioners an effective way to monitor the condition of a patient who is suffering from an evidence-based ventilation strategy (Rice & Janz, 2020). Through the system, it is easier for healthcare practitioners to examine the respiratory response. Based on the response, doctors can effectively deploy other systems, such as the lung-protection strategy (Modi & Mahboobi, 2020). As such, patients with breathing problems, especially those that need mechanical ventilators, can profoundly benefit from the system. The system reduces respiratory reserve, which exposes the lung to other problems (Rice & Janz, 2020). Despite the effectiveness of the system, nasal invasive positive pressure ventilation may trigger other negative effects, such as gastric perforation (Lentz et al., 2020).

In some conditions, the prone position has been perceived as an integral way of handling patients with an evidence-based ventilation strategy (Chi et al., 2012). Prone positioning is used in conjunction with positive end-expiratory pressure (PEEP), and this assists in maintaining the patient’s airway pressure above the condition (Diaconu et al., 2018). The approach promotes a safely ventilating system when dealing with patients suffering from acute respiratory distress syndrome (Chi et al., 2012). The approach profoundly improves arterial oxygenation as it changes chest surface and lung compliance when a patient is under mechanical ventilation (Millot et al., 2018).

Conclusion

In conclusion, in the two pathophysiological mechanisms, microaspiration is the most common across the world. The availability of tracheal tubes influences the ordinary role in protecting upper airway reflexes, and this hinders efficient coughing (Diaconu et al., 2018). As such, the availability of a tracheal tube creates a room that allows two channels for bacterial airways colonization, endoluminal, and extraluminal colonization (de Souza Kock & Maurici, 2018). As the condition continues, the oropharynx becomes hurriedly occupied by aerobic gram-negative bacteria. The affected materials above the tracheal tube cuff become aerated, and this allows them to access the lower airways through a fold in the surface of the cuff.