The patient needing prolonged mechanical ventilation: a narrative review

Area of Science:

• Critical Care Medicine
• Pulmonology
• Respiratory Therapy

Background:

• Improved intensive care unit management has increased survival but also the prevalence of patients needing prolonged mechanical ventilation.
• This leads to significant clinical, organizational, and resource challenges with poor long-term outcomes.
• A need exists to enhance the management of ventilator-dependent individuals.

Purpose of the Study:

• To review current concepts and challenges in the management of prolonged mechanical ventilation.
• To highlight areas requiring further research and standardized protocols.

Main Methods:

• This narrative review synthesizes information on prolonged mechanical ventilation and weaning.
• It examines recent developments in ventilatory strategies, mobilization, and specialized units.
• It also discusses controversies in nutritional support, tracheostomy timing, and decannulation protocols.

Main Results:

• Variability exists in terminology and definitions for prolonged mechanical ventilation.
• Data on discharge rates, home mechanical ventilation, and long-term survival are scarce.
• Consensus is lacking on optimal timing for tracheostomy, decannulation, and nutritional support.

Conclusions:

• Traditional intensive care units and current medical training are insufficient for managing these complex patients.
• Solutions require collaboration among healthcare professionals, families, and stakeholders.
• Large-scale, multinational studies are essential to address management gaps.