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Jul 12 th, 2024

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How Does a Ventilator Work

Dr. Sandeep Karanam, MD., DNB ( Pediatrics )

FELLOW IN PEDIATRIC INTENSIVE CARE RUGHS & LONDON,UK  

provides invaluable insights into the world of ventilators—essential medical devices that play a pivotal role in critical care scenarios.

This comprehensive guide aims to illuminate what ventilators are, how they function, and their profound impact on patient care.

Dr Sandeep Karanam

What is a ventilator?

A ventilator provides oxygen/air mix to the lungs through a tube placed in the mouth, nose or a small cut in the throat.

The air that is provided by the ventilator expands the lungs

How much ventilatory support is required will be dependent on patient need for lungs to work adequately.

A ventilator can provide full assistance with patient breathing or can give partial assistance while the patient’s takes the breath.

Intensive care doctors will update you regarding the need for ventilation and day to day care whilst on ventilator support.

Why do patients need a ventilator?

A ventilator is used for patients who need help with their breathing. This is often because the patient’s lungs need a rest or sometimes, they require assistance to their breathing like in conditions such as pneumonia. Ventilation is the common reason for admission in intensive care units.

What is intubation?

A ventilator will deliver the breath through a tube placed in the airway. This tube can be placed via mouth or the nose. The procedure of securing this tube is called Intubation.

What are the common conditions requiring ventilation?

For instances most commonly

  • for any surgeries under general anaesthesia and during post operative recovery – usually these are short duration ventilation
  • Respiratory failure – it can be any problem involving airways or lungs
  • Any cardiac problems involving low or high blood pressure emergencies, poor heart function, high lung pressures requiring special gases like nitric oxide
  • Any brain conditions affecting their consciousness like infections of the brain, head injury, uncontrolled seizures (fits is the commonly used term by patients)
  • Conditions like liver failure, kidney failure
  •  

Does a patient move on ventilator?

Patients can still move even when they were put on ventilator support. Patients can be uncomfortable with a tube placed in their mouth or nose and may try to take it off, in order avoid tube coming out they will receive medications to keep them asleep, comfortable and pain free. Depending on the level of comfort patients can still be able to do movements whilst on the ventilator support. Only in few instances patients will receive medication called muscle relaxants during which they cannot do any movements.

As the patient condition improves these medications are stopped and they will be assessed for the readiness to come off from the ventilator support. Intensive care doctors will explain you about all these things in detail.

How long does the patient stay on ventilation?

The length of time our patients may require to be on the ventilator will be dependent on the individual condition. Sometimes it is difficult to assess the length of time it will take for the patients to recover. However, doctors will update you day to day about the condition.

Usually if the ventilation is going beyond 2weeks, doctors will suggest about placing an alternate tube in the neck with small surgery called tracheostomy.

Does a patient on ventilator mean ultimate death?

No. Ventilation will help in recovery of the patient. There are risks of putting a patient on ventilator but doctors usually take the call if the benefits of putting a patient on ventilator outweighs risks.

What is DNI?

‘DO NOT INTUBATE or DO NOT RESUCSITATE’ are for the situations where continuing aggressive treatment will not help in patient recovery for example in advanced cancer patients who are under palliative care. Doctors will discuss about the resuscitation in detail with patient/relatives.

What are the side effects or aftereffects of the patient being on ventilator?

Ventilation might be necessary to help breathing but it does carry certain risks. Some examples are

  1. Trauma to the voice box and bleeding while placing a tube in the throat
  2. Narrowing of the airways if patient requires ventilation for longer period
  3. Lung infections
  4. Prolonged ventilation beyond 2 weeks can carry risk for lung damage
  5. Limitation in energy intake, weakness of muscles
  6. Can develop swelling of the body and Skin damage

All these will be taken in consideration by doctors before putting a patient on ventilator and they will assess patients daily for each and every complications and take necessary preventive and treatment measures.

Do we have alternate options for the ventilator to a patient?

It depends on the patient condition for which he/she needs to be put on ventilator. For example, there are no alternatives for surgeries under general anaesthesia, similarly for conditions involving poor consciousness.

For conditions involving lungs, doctors usually try alternative way of giving oxygen or respiratory support like providing oxygen, HFNC or Non invasive ventilation methods before going for ventilation.

Can we ventilate without tube In the mouth?

Non-invasive ventilation is one form of ventilation in which ventilator can be connected to the patient with face mask or nasal pillow, which can support patient respiratory efforts but this form of ventilation can be used in certain conditions only where patient condition meets all the criteria to use this form of ventilation.

Can a dead patient be kept on the ventilator?

A dead person does not show any signs of life that is

  1. They do not have a heartbeat – which can be seen on the monitor as a straight line unless the chest leads are disconnected.
  2. They do not show any breathing efforts – on the monitor patient oxygen levels are not recordable and if the patient is already on ventilator, you may notice movements of the chest because machine is delivering the breaths. Once patient is disconnected from the ventilator, he may not show any breathing movements.

Non – medical person needs to interpret this very cautiously because doctors must use certain medications called muscle relaxants for safely inserting the tube in the throat and these medications relaxes the muscles, so they are not able move.

  1. They do not show any signs of brain function -not awake (unless under sleeping medication), no response to pain, no cough, pupils dilated (doctors check this in patient’s eyes with light).
  2. Colour of the skin will pale and cold to touch

So, it is possible to put a dead person on ventilator but only as an attempt to revive his heart but cannot be continued beyond few minutes if his heart does not start functioning.

Conclusion

Understanding ventilators is paramount for both healthcare providers and patients navigating critical health challenges. Dr. Sandeep Karanam, insights underscore the significance of these devices in medical emergencies and recovery phases, guided by compassionate and informed care practices. If you have any health-related questions, don’t hesitate to ask at HealthHOD.com.

If you have any kind of medical-related doubt, use these simple steps and then ask your question at Healthhod.com.

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