Patients who require prolonged invasive mechanical ventilation pose a unique set of circumstances to the pulmonary and critical care practitioner. This requires a delineation of the primary cause for respiratory failure, and, in most cases, a comprehensive multidisciplinary approach to the treatment of not only the primary disturbance causing respiratory failure, but the consequences that immobility, illness, and prolonged ventilation have on swallowing and ambulatory function, psychosocial interaction, and the ability to wean from mechanical ventilation. The development of multidisciplinary rehabilitative units for patients requiring prolonged mechanical ventilation have showed not only a reduction in hospital costs and lengths of stay, but also an improvement in patient survival, functional status, reduction in ventilator days or need for mechanical ventilation at discharge, and, overall, the achievement of a satisfactory quality of life.