The adverse effects and complications of mechanical ventilation may arise from the artificial airway or from positive pressure ventilation and the drugs required to facilitate this. The occurrence of complications cannot be completely eliminated, but an appropriately managed intensive care unit will monitor the occurrence of complications and use this information to look for trends, to learn from the lessons that each complication can teach and as a quality assessment and quality assurance tool.

Intubation and the artificial airway

Immediate complications

Airway management and intubation in the operating department are performed under ideal circumstances with anaesthetists working in familiar, well-equipped surroundings supported by competent assistants on patients who, in the vast majority of cases, have been assessed and prepared for the procedure. Consequently, the complication rate is very low (Table 14.1). In contrast, airway management away from the operating department is often performed by non-anaesthetists, in more challenging locations, with little or no help, and on patients who, for the large part, need urgent airway management because of their poor or deteriorating condition. Not surprisingly, the complication rate in these patients is considerably higher (Table 14.1). A significant contributory factor to the increased incidence of complications is the frequency of difficult intubation reported in these patients (Table 14.2), which is caused by the interaction between inexperienced operators and difficult circumstances (Figure 14.1).