Invasive Mechanical Ventilation: When and to whom? Indications and complications of Invasive Mechanical Ventilation

Although emergency endotracheal intubation and mechanical ventilation (MV) are undoubtedly a life-saving intervention, deciding when and whom to support remains challenging. Common indications include respiratory failure, shock, coma and operative procedures that require analgesia and sedation. Endotracheal intubation is well known for its potential difficulty and mechanical ventilation is associated with complications that may aggravate the critically ill patient. Although MV is used in intensive care units in order to maintain adequate gas exchange and decrease the work of breathing, these goals may be difficult to achieve if there is no proper interaction between patient and ventilator (patient-ventilator asynchrony). Therefore, it is important that clinicians suspect, recognize and resolve appropriately any adverse consequence associated with this intervention. Finally, with the widespread use of mechanical ventilation, ethical challenges arise; patients with terminal illnesses can be kept alive, with little to no prospect of having their underlying condition cured or improved. Of paramount importance is for chronically ill patients to partake in the decision to institute or withhold MV after being appropriately informed for its indications and limitations.