Complications of Mechanical Ventilation: Nursing Assessment and Management
Abstract
Background: Mechanical ventilation is a life-saving intervention for critically ill patients but is associated with significant complications, including ventilator-associated events (VAEs), ventilator-induced lung injury (VILI), and ventilator-associated pneumonia (VAP). These complications increase morbidity, mortality, and healthcare costs.
Aim: To review the complications of mechanical ventilation and outline nursing assessment and management strategies to mitigate these risks.
Methods: This narrative review synthesizes evidence from CDC surveillance frameworks, epidemiologic studies, and clinical guidelines, focusing on pathophysiology, risk factors, and preventive strategies for VAEs, VILI, and VAP.
Results: VAEs occur in 5–6% of ventilated patients, with infection-related complications and VAP contributing to prolonged ICU stays and higher mortality. VILI mechanisms include atelectrauma, barotrauma, volutrauma, and biotrauma, while VAP remains a major infectious complication, often caused by multidrug-resistant organisms. Preventive strategies include lung-protective ventilation (low tidal volume, optimal PEEP), prone positioning, ECMO in severe cases, and ventilator bundles incorporating head-of-bed elevation, oral care, and sedation management. Nursing plays a pivotal role in implementing these interventions, monitoring for early deterioration, and ensuring multidisciplinary coordination.
Conclusion: Mechanical ventilation, while essential, carries substantial risk. Evidence-based preventive strategies and vigilant nursing care are critical to reducing complications and improving outcomes.
Full text article
References
Slutsky AS, Ranieri VM. Ventilator-induced lung injury. The New England journal of medicine. 2013 Nov 28:369(22):2126-36. doi: 10.1056/NEJMra1208707.
Mietto C, Pinciroli R, Patel N, Berra L. Ventilator associated pneumonia: evolving definitions and preventive strategies. Respiratory care. 2013 Jun:58(6):990-1007. doi: 10.4187/respcare.02380.
Magill SS, Rhodes B, Klompas M. Improving ventilator-associated event surveillance in the National Healthcare Safety Network and addressing knowledge gaps: update and review. Current opinion in infectious diseases. 2014 Aug:27(4):394-400. doi: 10.1097/QCO.0000000000000083.
Klompas M, Berra L. Should Ventilator-Associated Events become a Quality Indicator for ICUs? Respiratory care. 2016 Jun:61(6):723-36. doi: 10.4187/respcare.04548.
Spalding MC, Cripps MW, Minshall CT. Ventilator-Associated Pneumonia: New Definitions. Critical care clinics. 2017 Apr:33(2):277-292. doi: 10.1016/j.ccc.2016.12.009.
Klompas M, Kleinman K, Murphy MV. Descriptive epidemiology and attributable morbidity of ventilator-associated events. Infection control and hospital epidemiology. 2014 May:35(5):502-10. doi: 10.1086/675834.
Kobayashi H, Uchino S, Takinami M, Uezono S. The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation. Respiratory care. 2017 Nov:62(11):1379-1386. doi: 10.4187/respcare.05073.
Magill SS, Edwards JR, Fridkin SK, Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Survey of health care-associated infections. The New England journal of medicine. 2014 Jun 26:370(26):2542-3. doi: 10.1056/NEJMc1405194.
Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, Keohane C, Denham CR, Bates DW. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA internal medicine. 2013 Dec 9-23:173(22):2039-46. doi: 10.1001/jamainternmed.2013.9763.
Griesdale DE, Bosma TL, Kurth T, Isac G, Chittock DR. Complications of endotracheal intubation in the critically ill. Intensive care medicine. 2008 Oct:34(10):1835-42. doi: 10.1007/s00134-008-1205-6.
Beitler JR, Malhotra A, Thompson BT. Ventilator-induced Lung Injury. Clinics in chest medicine. 2016 Dec:37(4):633-646. doi: 10.1016/j.ccm.2016.07.004
Gordo-Vidal F, Calvo-Herranz E, Abella-Alvarez A, Salinas-Gabiña I. [Hyperoxia-induced pulmonary toxicity]. Medicina intensiva. 2010 Mar:34(2):134-8. doi: 10.1016/j.medin.2009.04.007.
Laghi F, Goyal A. Auto-PEEP in respiratory failure. Minerva anestesiologica. 2012 Feb:78(2):201-21
American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. American journal of respiratory and critical care medicine. 2005 Feb 15:171(4):388-416
Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, O'Grady NP, Bartlett JG, Carratalà J, El Solh AA, Ewig S, Fey PD, File TM Jr, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2016 Sep 1:63(5):e61-e111. doi: 10.1093/cid/ciw353.
Zilberberg MD, Shorr AF. Ventilator-associated pneumonia: the clinical pulmonary infection score as a surrogate for diagnostics and outcome. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2010 Aug 1:51 Suppl 1():S131-5. doi: 10.1086/653062.
Kollef MH. Ventilator-associated complications, including infection-related complications: the way forward. Critical care clinics. 2013 Jan:29(1):33-50. doi: 10.1016/j.ccc.2012.10.004.
Wu D, Wu C, Zhang S, Zhong Y. Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients. Frontiers in pharmacology. 2019:10():482. doi: 10.3389/fphar.2019.00482.
Restrepo MI, Anzueto A, Arroliga AC, Afessa B, Atkinson MJ, Ho NJ, Schinner R, Bracken RL, Kollef MH. Economic burden of ventilator-associated pneumonia based on total resource utilization. Infection control and hospital epidemiology. 2010 May:31(5):509-15. doi: 10.1086/651669.
Kallet RH, Quinn TE. The gastrointestinal tract and ventilator-associated pneumonia. Respiratory care. 2005 Jul:50(7):910-21; discussion 921-3
Neuville M, Mourvillier B, Bouadma L, Timsit JF. Bundle of care decreased ventilator-associated events-implications for ventilator-associated pneumonia prevention. Journal of thoracic disease. 2017 Mar:9(3):430-433. doi: 10.21037/jtd.2017.02.72.
Burja S, Belec T, Bizjak N, Mori J, Markota A, Sinkovič A. Efficacy of a bundle approach in preventing the incidence of ventilator associated pneumonia (VAP). Bosnian journal of basic medical sciences. 2018 Feb 20:18(1):105-109. doi: 10.17305/bjbms.2017.2278.
Klompas M, Anderson D, Trick W, Babcock H, Kerlin MP, Li L, Sinkowitz-Cochran R, Ely EW, Jernigan J, Magill S, Lyles R, O'Neil C, Kitch BT, Arrington E, Balas MC, Kleinman K, Bruce C, Lankiewicz J, Murphy MV, E Cox C, Lautenbach E, Sexton D, Fraser V, Weinstein RA, Platt R, CDC Prevention Epicenters. The preventability of ventilator-associated events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative. American journal of respiratory and critical care medicine. 2015 Feb 1:191(3):292-301. doi: 10.1164/rccm.201407-1394OC.
Geiseler J, Kelbel C. [Weaning from mechanical ventilation. Weaning categories and weaning concepts]. Medizinische Klinik, Intensivmedizin und Notfallmedizin. 2016 Apr:111(3):208-14. doi: 10.1007/s00063-016-0147-y.
Parisi M, Gerovasili V, Dimopoulos S, Kampisiouli E, Goga C, Perivolioti E, Argyropoulou A, Routsi C, Tsiodras S, Nanas S. Use of Ventilator Bundle and Staff Education to Decrease Ventilator-Associated Pneumonia in Intensive Care Patients. Critical care nurse. 2016 Oct:36(5):e1-e7
Williams LM, Sharma S. Ventilator Safety. StatPearls. 2025 Jan
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet (London, England). 2009 May 30:373(9678):1874-82. doi: 10.1016/S0140-6736(09)60658-9.
Wang TH, Wu CP, Wang LY. Chest physiotherapy with early mobilization may improve extubation outcome in critically ill patients in the intensive care units. The clinical respiratory journal. 2018 Nov:12(11):2613-2621. doi: 10.1111/crj.12965.
Elke G, van Zanten AR, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, Jiang X, Day AG, Heyland DK. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Critical care (London, England). 2016 Apr 29:20(1):117. doi: 10.1186/s13054-016-1298-1.
Dosher WB, Loomis EC, Richardson SL, Crowell JA, Waltman RD, Miller LD, Nazim M, Khasawneh FA. The effect of a nurse-led multidisciplinary team on ventilator-associated pneumonia rates. Critical care research and practice. 2014:2014():682621. doi: 10.1155/2014/682621.
Authors
Copyright (c) 2025 Aminah Mousa Alsadah, Alhussain Mohammad Sirius, Abdiya Abdulaziz Al-Hussein, Amal Abdulaziz Al-Hussain Al-Sada, Suaad Abdulaziz Al-Hussein, Zahra Ali Hussein Moafa, Hailah Rashed Saud Aldosari, Basmah Essa Ali Alali, Anud Eissa Ali Marzouq, Amal Ali Ahmed Qubuli, Afrah Saqer Saeed Almutairi, Hadi Ibrahim Mofarh Atafi, Hassan Ali Hassan Alasmari
This work is licensed under a Creative Commons Attribution 4.0 International License.