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MECHANICAL VENTILATION 

 

A mechanical ventilator which is also known as ventilator or respirator is a life support device. It helps a patient to breathe when they are unable to breathe on their own. It also helps patient to breathe when they are recovering from any critical illness or surgery. A patient is connected to the ventilator with the help of a hollow tube which is removed when the patient starts breathing normally on their own. 

A mechanical ventilator is used for the following:

  • To supply oxygen rich air to the lungs
  • To remove carbon dioxide from the lungs
  • To ease the work of breathing(especially for those who have severe difficulty in breath)
  • To help the patient who has weak respiratory muscles

Indications for Mechanical Ventilation 

The following are the common indications of mechanical ventilation:

  • Bradypnea
  • Tachypnea
  • Uncontrolled hypotension
  • Acute lung injury
  • Neuromuscular disease that affect the respiratory muscles
  • Respiratory muscle fatigue
  • Respiratory distress syndrome
  • Insufficient alveolar ventilation

Working of a Ventilator

A ventilator is connected to a patient with the help of a tube called endotracheal tube (ET) which is inserted through nose or mouth and pushed down into the windpipe (trachea). The process of inserting the ET tube into patient’s windpipe is called as intubation. In some patients, a surgery is performed to make a hole in the neck through which the tube that is connected to the ventilator is inserted. This surgery is referred to as tracheostomy.  The ventilator delivers air to the patient though the tubes. The ventilator may completely control breathing when a patient is unable to breathe at all. In other cases, in which the patient’s breathing is impaired, the ventilator assists in breathing. The respiratory secretions tend to get settled on the ventilator tubes which need to be removed regularly to prevent obstruction and infection of the airways.  These secretions are removed through suction.

The team of healthcare professionals who care for the patients on mechanical ventilation include- anesthesiologist, pulmonologists, critical care physicians, critical care nurses and respiratory therapists.

Monitoring of Patients on Ventilator

Patients on the ventilator are also connected to a monitor which measures the patient’s heart rate, blood pressure, and oxygen saturation. Other tests for assessing the health of a patient on mechanical ventilator may include chest x-rays and measurement of blood gases. The healthcare team uses this information to assess the health condition of the patient and may adjust the settings of the ventilator if required.

Risks and Complications of Mechanical Ventilator

A mechanical ventilator may be lifesaving, but it also has its risks. The following conditions may occur while a patientis on a mechanical ventilator:

  • Lung infections like Pneumonia
  • Pneumothorax which may cause lung collapse
  • Subcutaneous emphysema 
  • Acute respiratory distress syndrome
  • Ventilator-associated lung injury
  • Pneumoperitoneum (air in the peritoneum)
  • Pneumomediastinum (Air in the mediastinum)

 

Benefits of Mechanical Ventilator

Mechanical ventilation does not heal the patient instead it allows the patient to maintain normal blood gas levels (oxygen and carbon dioxide) unless the patient’s condition is stabilised.  The following are the main benefits of the mechanical ventilation:

  • It helps in preserving the airway of the patient
  • It helps in reducing the difficulty of breathing in the patients with impaired respiratory function.
  • It helps patients to attain the required oxygen levels in blood. It provides higher oxygen levels than delivered by masks or other devices.
  • It also provides positive end expiratory pressure(PEEP) which keeps the airways and air sacs open and does not allow them to collapse.
  •  It helps to maintain respiratory function until the patient has recovered and is able to breathe normally. 

Duration of use of a mechanical ventilator           

The main aim of using a mechanical ventilator is to maintain respiratory function of the patient until his/her health is stable. The healthcare team performs a series of tests to check the patient’s ability to breathe on their own. The mechanical ventilator can be removed as soon as a patient resumes normal breathing.

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