Prolonged mechanical ventilation (PMV) is defined as requiring mechanical ventilation for greater than 14 to 21 days for acute illness or injury. Use of the ProVent14 score to assess expected survival can guide provider communication with patients and caregivers. Placement of a tracheostomy can aid recovery and liberation from mechanical ventilation, but usually should not be pursued before day 10 of mechanical ventilation. Effective weaning for PMV patients should consist of daily trials on tracheostomy collar until the patient is successfully liberated. Early mobility and use of speaking valves while still requiring ventilator support improves functional outcomes and communication with patients. Transfer to long-term acute care hospitals (LTACs) have the potential to reduce the overall cost of the episode of care by reducing readmissions to acute care hospitals. Coordination of outpatient care in post-ICU clinics could improve evaluation of post-intensive care syndrome.