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The Life-Saving Role of Ventilators in ICU

 If any patient is in critical condition, it often happens that they develop breathing difficulty due to the underlying disease. In these critical situations, ventilators are used to provide oxygen to the lungs for body functioning. Ventilators are used for around 40% of patients admitted to ICUs to assist with breathing when they cannot breathe adequately on their own.

 

When do patients require ventilators in the ICU?

 

Patients who catch diseases that block the natural capability of the lungs to take air in & exhale out may often require additional oxygen support to assist in breathing. If their conditions worsens, they must be put in Intensive Care Units (ICUs), as they may require ventilators. Some of the complications and diseases for which patients are put on ventilator support include severe asthma attacks, pneumonia and acute respiratory distress syndrome (white lungs)

Apart from the above-mentioned lung diseases, there are many critical conditions in which ventilators are life-saving despite the fact that the lungs remain healthy. These conditions include unconsciousness due to any reason and multiple organ failure.

In these complex diseases, the lungs cannot naturally provide the body with the oxygen that’s required for its normal functions. What a ventilator does is that it secures the windpipe with the help of tubes and oxygenates the body by supplying oxygen in it and sucking out carbon dioxide. 

 

How Does a Ventilator Work?


Ventilators, to a certain extent, work the same way a human lung works. Apart from maintaining the natural process of oxygen intake or carbon dioxide removal, ventilators also maintain the required air pressure to the lungs. In certain diseased conditions, the lung pressure requirements become very high also known as Acute Respiratory Distress Syndrome which can be controlled only through ventilators.

A ventilator is a machine which works to assist the lungs, it can be connected to the patient’s lungs either by a tight-fitting face mask or with a tube in the patient's windpipe via nose or mouth. The ventilator tubing connects the above two and blows oxygen-rich air into the lungs. This oxygen-rich air first passes through a humidifier which keeps the air warm and moist. The ventilator helps the patient to breathe in and out and maintains a constant pressure inside the lungs which prevents the air sacks from collapsing. 

How Does the Ventilator Management been done? 

: Role of a Super-specialized ICU doctor team


A ventilator is a machine which has been used in many critical patients and almost every patient who suffers from respiratory failure. But the most important point of concern is who is operating these machines on your patients. 

Technology has advanced conventional ventilators, which can be used in multiple ways depending upon the exact needs of the patients. The Critical Care doctors who have a super-specialized medical degree in Critical care medicine are the right people who can manage the ventilator well on every kind of patient as per their breathing needs. The availability of these doctors for round-the-clock patient management is crucial as they are the people who understand the disease and medical science behind it and therefore able to provide personalized ventilator settings to patients. Sometimes patients on ventilators require mild tranquilizers to help them breathe easily. Synchronizing the ventilator settings with patient breathing may further decrease the need for sedatives which gives better patient outcomes.


How Does the care of a patient on Ventilator been done? 

: Role of a state of art nursing care and rehabilitation team


The patients who require ventilator support have been given special comprehensive care for their all-body functions. That starts with the care of eyes, face, oral hygiene, hair, skin, and pressure areas. Feeding is always done with a food pipe in the stomach, with a liquid feed containing all nutritional requirements that help to provide energy this critical condition.

Special care for the tube placed in the lungs, tubes attached to a ventilator, and lungs with the help of nebulization, physiotherapy, and regular positioning helps a patient to improve faster. Along with this the muscle power and joint functions must be taken care of with regular exercise of both hands and legs. It helps patients gain faster recovery when we plan to decrease ventilator support or remove of ventilator. Therefore, it’s not a one-man job, it requires a team of ICU doctors, ICU nurses, physiotherapists and nutritionists all play a very important role in managing patients on ventilators.


Types of Mechanical Ventilation


Ventilators are devices made to support the breathing. Nowadays, there are a variety of ventilators available with newer modes which allow easy breathing for patients. Based on the fact, that a person is connected to the ventilator and supports their breathing, ventilation can be non-invasive or invasive. 

1. Noninvasive ventilation

 

It is a type of ventilation that involves the usage of a tight-fitting mask, it can be through the nose only or nose and mouth or in the shape of a helmet which is connected through a tubing to the ventilator. The patient can breathe into the mask or helmet which will be strapped around its head. These patients might need tube feeding for continuous breathing. This method is quite useful in COPD and heart failure patients and has proven benefits.

The non-invasive ventilation also includes devices for Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) machines. They are smaller devices and do not have capability as high as ICU ventilators. Both of these machines are also used by people with sleep apnea as a home therapy.

 2. Invasive ventilation


This type of ventilation involves a tube in the patient’s windpipe via nose or mouth (intubation) or neck (tracheostomy), which is connected through a tubing to the ventilator. This is a life-saving method to provide adequate oxygen and remove the CO2 from the lungs in a critically ill patient.  

3. Manual resuscitator bag

 

A manual resuscitator bag is a type of ventilation process where a self-inflating bag is used to provide breath that helps the airflow in and out of the patient’s lungs. This is also called an AMBU (Artificial Manual Breathing Unit) bag, used as a temporary method to revive sick patients or when the ventilator facility is not available, like in peripheral or low-resource setting areas. It can be attached with the help of a tight-fitting face mask or a tube placed in a windpipe. 

What are the Uses of Ventilator?


The usage of ventilators depends upon the patient's disease and the expected duration of how long the ventilator will be needed or when the underlying disease condition will resolve with the treatment. There are a few conditions in which ventilators are a must.


1. Ventilator for surgery

 General anaesthesia given for a surgical procedure includes placing the patient on a ventilator during a surgical procedure in the operation theatre.  This is part of providing general anaesthesia so that the patient does not feel any pain during the surgery.

2. Ventilator for respiratory failure

 Respiratory failure is a condition when the patient is not able to get adequate oxygen or remove CO2 or faces extreme difficulties to breath on their own and maintaining above two. If a patient suffers from respiratory failure due to any reason the medical treatment is to support his/ her breathing through a ventilator. 

It can occur due to chest infection (pneumonia), septicemia with multi-organ failure, heart failure, aspiration of stomach content into the lungs, blockage of lung’s blood vessels, drug overdose or any type of direct injury to the lungs or spinal cord causing loss of control of lung function. 

3. Brain injury or stroke

Some conditions unrelated to the lungs also cause respiratory problems, like the inability to swallow or cough out things away from the windpipe. These are related to the control of breathing or throat muscles which are governed by the brain, which is an orchestra of all body organs.  They include brain injury during high-speed accidents or stroke also known as brain attack.

These patients sometimes also require a ventilator because of a coma, which makes them unable to maintain their breathing. It can last for longer periods of time because of slowness in the brain function recovery after any kind of insult. 

Conclusion

 

A ventilator is a crucial medical device that helps the patient to breathe during difficult conditions. The device can provide full breathing support to the hospitalized patient and acts as a life support. These patients require extreme care in all aspects till their recovery.

Ventilators require highly skilled doctors to provide adequate care to the patient. The ventilator delivers a fixed flow of air or purified oxygen to the patient’s lungs through a mask or tube. This oxygen travels and helps to maintain a proper exchange of gases between the body tissues.

Dr. Dilip Dubey
Critical Care
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