Ventilator therapy complications

Medical Management No specific viral therapy exists so treatment is supportive only. Treat patients with uncomplicated VEE infection with analgesics to relieve headache and myalgia. Patients who develop encephalitis could require anticonvulsants and intensive care to maintain fluid and electrolyte balance, ensure adequate ventilation, and avoid complicating secondary bacterial infections. Patients should be treated in a screened room or in quarters treated with residual insecticide for at least five days after onset, or until afebrile (without fever) to foil mosquitoes since humans may remain infectious for mosquitoes for at least seventy-two hours. Isolation and qaurantine is not required. Standard Precautions should be practiced when dealing with infection control for VEE victims as shown below ... 

As would be expected from the interruption of acetylcholine neuromuscular transmission, electrophysiological studies show smaller than normal motor unit potentials in the victim s muscles. The only specific treatment available is passive immunization with an antitoxin. This will not reverse the paralysis but can help to stabilize the decline. The antitoxin available is from an equine source and thus there can be complications for the patient such as anaphylaxis. The main therapy is supportive care - often involving maintenance of ventilation - over the longer term until normal functions recover. 

Hermans G, Wilmer A, Meersseman W, et al. Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit. Am J Respir Grit Care Med 2007 175(5) 480-489. 

Few, if any, patients with NMD should be left to develop unexpected ventilatory failure as appropriate assessment, self-management education, and follow-up will identify disease progression and risk of respiratory complications. When ventilatory failure occurs, tracheostomy tubes can be avoided, for the most part, irrespective of the degree of ventilator dependence, with the exception of those with insufficient bulbar-innervated musculature for speech, deglutition, and airway protection. Those with indwelling tracheostomy tubes should be offered decannulation as part of their rehabilitation, irrespective of the extent of their respiratory muscle failure. The only exceptions to this therapy are patients with advanced bulbar ALS or those with rare facioscapulohumeral muscular dystrophy, who lose all bulbar-innervated muscle function and aspirate saliva to the extent of Sao2 remaining below 95% (13). 

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