What are the common complications associated with invasive mechanical ventilation that I should monitor for in my patients?

Common complications associated with invasive mechanical ventilation that require monitoring include ventilator-associated pneumonia, barotrauma (such as pneumothorax), volutrauma, oxygen toxicity, hemodynamic instability, and neurodevelopmental impairment in neonates. Additionally, complications related to sedation and analgesia, secretion management difficulties, and endocrine disturbances may occur.

Specifically, ventilator-associated pneumonia is a frequent infectious complication due to prolonged intubation and impaired airway defenses. Barotrauma and volutrauma result from excessive airway pressures or volumes, causing lung injury. Oxygen toxicity can arise from prolonged exposure to high oxygen concentrations, necessitating careful oxygen saturation monitoring, especially in preterm infants where target saturations are 91% to 95% ¹. Hemodynamic instability may occur, but treatment should focus on improving tissue perfusion rather than solely correcting blood pressure thresholds ¹.

In neonates, invasive ventilation is also associated with risks of neurodevelopmental impairment, including cerebral palsy and sensory deficits, which should be considered during long-term follow-up ¹. Sedation, such as morphine use, should be carefully assessed and not routinely administered unless pain is evident ¹.

Secretion management is critical, as ventilated patients often have impaired cough and secretion clearance, increasing the risk of airway obstruction and infection (Newsome et al., 2018). Endocrinological problems, including disturbances in growth and metabolism, have been reported in children on home invasive mechanical ventilation, highlighting the need for multidisciplinary monitoring (Şiklar, 2024).

Overall, continuous monitoring of oxygenation, carbon dioxide levels, respiratory mechanics, and signs of infection or lung injury is essential. Multidisciplinary care plans should include regular clinical reviews, respiratory function tests, and support for secretion management to mitigate these complications ¹[(Newsome et al., 2018); (Şiklar, 2024)].