Advances in mechanical ventilation for critically ill patients: strategies for respiratory support and complication management.

Mechanical ventilation is essential for supporting critically ill patients with acute respiratory failure, especially those with acute respiratory distress syndrome (ARDS). In recent years, the focus of mechanical ventilation has shifted from simply improving gas exchange to implementing strategies that protect both the lungs and other organs. Lung-protective ventilation strategies - specifically low tidal volume ventilation and airway pressure limitation - have been shown to improve patient outcomes and are now considered standard care. More recent studies have emphasized the importance of driving pressure, individual positive end-expiratory pressure (PEEP) titration, and lung recruitability assessment in optimizing ventilation. Methods such as prone positioning, high-flow nasal cannula (HFNC) oxygen therapy, and noninvasive ventilation (NIV) have further expanded options for respiratory support. Simultaneously, emerging concepts such as patient self-inflicted lung injury (P-SILI), patient-ventilator asynchronies, and diaphragm dysfunction have enhanced our understanding of ventilator-related pathophysiology. Nonetheless, mechanical ventilation remains associated with various complications, including ventilator-induced lung injury (VILI), ventilator-associated pneumonia (VAP), intensive care unit-acquired weakness (ICUAW), and delirium. Effective prevention and management of these complications require an integrated approach, encompassing lung-protective ventilation, optimized sedation, early mobilization, and standardized weaning protocols. The potential of advanced monitoring and supportive technologies, such as electrical impedance tomography, esophageal pressure monitoring, closed-loop ventilation systems, and AI-assisted decision-making, continues to evolve. This review summarizes recent advances in clinical mechanical ventilation, including its underlying mechanisms, associated complications, and current prevention and treatment strategies, which may serve as references for the care of critically ill patients requiring respiratory support.