Complications in preserving the airway in intensive care unit patients

Maintaining the airway in patients in intensive care unit (ICU) is often a vitally important issue for successful treatment of patients. The aim of the study was to identify the complications as the most common causes of difficult ventilation in ICU patients. This retrospective study included 12 patients with difficult pulmonary ventilation, aged 12-70 years, 8 male and 4 female. All patients were intubated for a period of 7-14 days on mechanical ventilation. Due to the need of prolonged mechanical ventilation, the patients underwent surgical tracheotomy and tracheal cannula was placed in five patients. Patients with unilateral atelectasis of the lung underwent bronchoscopy and airway lavage. All patients underwent regular intensive clinical observation and diagnosis, x-ray, CT and MRI. They all were administered antibiotic therapy as well as symptomatic and supportive therapy. Five patients underwent tracheotomy. In one patient with Down syndrome, tracheal rupture occurred two hours after general anesthesia. He developed massive pleural, mediastinal and subcutaneous emphysema. Seven patients with unilateral atelectasis of the lung underwent bronchoscopy and airway lavage. In two patients, therapeutic bronchoscopy with lavage was repeated twice, and in one patient bronchoscopy was repeated 4 times over a 6-month period. Eight patients died and four patients survived. Of the patients with polytrauma, two were in vigil coma, one survived for 6 months, while the other died from respiratory failure. In conclusion, it is important to promptly recognize and appropriately treat complications while maintaining airway in ICU patients, especially those with multiple trauma or conditions after extensive surgery. Preventing hypoxemia as a result of hypoxia has a far-reaching significance for the clinical course and success of patient treatment.