Complications of Prolonged Mechanical Ventilation

During prolonged mechanical ventilation (PMV) usually, the pediatric patients associate several complications that could modify the prognosis and clinical evolution. We described the most frequent complications such as nosocomial infections, highlighting ventilator-associated pneumonia (VAP), muscular atrophy, upper airway stenosis, delirium and withdrawal syndrome, malnutrition, developmental issues, and increased length of pediatric intensive care unit (PICU) stay. When a tracheostomy is necessary, complications appear with more frequency, and healthcare levels have to increase. Its prevention is crucial, so using appropriate devices for ventilation and humidification is essential. Secondly, acute complications could appear in any moment during mechanical ventilation (MV) period: pneumothorax, pneumomediastinum, subcutaneous emphysema, bronchopleural fistula, atelectasis, selective intubation, nonprogrammed extubation, obstruction, bleeding, and skin sores. Last but not least, the production or perpetuation of acute lung injury and the injury to organs distant from the lung, mainly through the release of inflammatory mediators into the systemic circulation (biotrauma), may be considered. The injury mechanisms due to volutrauma, barotrauma, atelectrauma, biotrauma, or ergotrauma must be controlled to minimize the damage produced to the noble organ that is the lung of the pediatric patient.