Understanding mechanical ventilation: patient monitoring, complications, and weaning.

Mechanical ventilation can provide life saving support to critically ill patients with respiratory failure. The implementation of appropriate monitoring techniques and an awareness of potential complications can increase the safety of mechanical ventilation. Several efficacious weaning methods can be utilized and none is clearly superior to the others. The improper use of any weaning technique can result in respiratory muscle fatigue delaying extubation. Determining patient suitability for extubation is an inexact science. The physical examination during a spontaneous breathing trial and the use of the rapid shallow breathing index can assist the clinician in the difficult decision as to the timing of extubation.