Mechanical Ventilation Errors and Patient Safety: A Narrative Review

Abstract

Mechanical ventilation is a life-saving intervention in critical care and emergency medicine, yet it remains a high-risk therapy because outcomes depend on correct configuration of ventilator settings, continuous monitoring, timely troubleshooting, and reliable teamwork. Mechanical ventilation–related errors occur at initiation, during ongoing titration, and during weaning and extubation. Common errors include inaccurate tidal volume selection (often not based on predicted body weight), failure to measure and limit plateau or driving pressure, inappropriate positive end-expiratory pressure (PEEP) application, inadequate alarm configuration and response, delayed recognition of patient–ventilator asynchrony, and unsafe sedation and liberation practices. These errors can precipitate ventilator-induced lung injury (VILI), hemodynamic compromise, prolonged mechanical ventilation, ventilator-associated complications, longer intensive care unit (ICU) length of stay, and increased mortality. This narrative review synthesizes key evidence and translates it into a patient safety framework. We classify ventilation errors into setting-related, monitoring/alarm-related, and human/system-related domains, describe mechanisms linking errors to harm, and summarize evidence-based prevention strategies. Practical tools are provided, including tables that map errors to consequences and a daily ventilator safety checklist that can be embedded into ICU workflows. A systems approach combining lung-protective ventilation, structured monitoring, standardized handover, competency-based education, and continuous quality improvement is essential to reduce preventable harm in mechanically ventilated patients.