Ventilator/Ventilator Support

A ventilator (VEN-til-a-tor) is a machine that supports breathing. These machines mainly are used in hospitals. Ventilators:

• Get oxygen into the lungs.
• Remove carbon dioxide from the body. (Carbon dioxide is a waste gas that can be toxic.)
• Help people breathe easier.
• Breathe for people who have lost all ability to breathe on their own.

A ventilator often is used for short periods, such as during surgery when you're under general anesthesia (AN-es-THE-ze-ah). The term "anesthesia" refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep.

The medicines used to induce anesthesia can disrupt normal breathing. A ventilator helps make sure that you continue breathing during surgery.

A ventilator also may be used during treatment for a serious lung disease or other condition that affects normal breathing.

Some people may need to use ventilators long term or for the rest of their lives. In these cases, the machines can be used outside of the hospital—in long-term care facilities or at home.

A ventilator doesn't treat a disease or condition. It's used only for life support.

• Mechanical ventilator
• Respirator
• Breathing machine

Ventilators most often are used:

• During surgery if you're under anesthesia (that is, if you're given medicine that makes you sleep and/or causes a loss of feeling)
• If a disease or condition impairs your lung function

During Surgery

If you have general anesthesia during surgery, you'll likely be connected to a ventilator. The medicines used to induce anesthesia can disrupt normal breathing. A ventilator helps make sure that you continue breathing during surgery.

After surgery, you may not even know you were connected to a ventilator. The only sign may be a slight sore throat for a short time. The sore throat is caused by the tube that connects the ventilator to your airway.

Once the anesthesia wears off and you begin breathing on your own, the ventilator is disconnected. The tube in your throat also is taken out. This usually happens before you completely wake up from surgery.

However, depending on the type of surgery you have, you could stay on a ventilator for a few hours to several days after your surgery. Most people who have anesthesia during surgery only need a ventilator for a short time, though.

For Impaired Lung Function

You may need a ventilator if a disease, condition, or other factor has impaired your breathing. Although you might be able to breathe on your own, it's very hard work. You may feel short of breath and uncomfortable. A ventilator can help ease the work of breathing. People who can't breathe on their own also use ventilators.

Many diseases, conditions, and factors can affect lung function. Examples include:

• Pneumonia (nu-MO-ne-ah) and other infections
• COPD (chronic obstructive pulmonary disease) or other lung diseases
• Upper spinal cord injuries, polio, amyotrophic lateral sclerosis (ALS), myasthenia gravis, and other diseases or factors that affect the nerves and muscles involved in breathing
• Brain injury or stroke
• Drug overdose

A ventilator helps you breathe until you recover. If you can't recover enough to breathe on your own, you may need a ventilator for the rest of your life.

Ventilators blow air—or air with extra oxygen—into the airways and then the lungs. The airways are pipes that carry oxygen-rich air to your lungs. They also carry carbon dioxide, a waste gas, out of your lungs.

The airways include your:

• Nose and linked air passages, called nasal cavities
• Mouth
• Larynx (LAR-ingks), or voice box
• Trachea (TRA-ke-ah), or windpipe
• Tubes called bronchial tubes or bronchi, and their branches

For more information about the airways, go to the Health Topics How the Lungs Work article.

The Breathing Tube

A ventilator blows air into your airways through a breathing tube. One end of the tube is inserted into your windpipe and the other end is attached to the ventilator. The breathing tube serves as an airway by letting air and oxygen from the ventilator flow into the lungs.

The process of inserting the tube into your windpipe is called intubation (in-too-BA-shun). Usually, the breathing tube is put into your windpipe through your nose or mouth. The tube is then moved down into your throat. A tube placed like this is called an endotracheal (en-do-TRA-ke-al) tube.

In an emergency, you're given medicine to make you sleepy and ease the pain of the breathing tube being put into your windpipe. If it's not an emergency, the procedure is done in an operating room using anesthesia. (That is, you're given medicine that makes you sleep and/or causes a loss of feeling.)

An endotracheal tube is held in place by tape or with an endotracheal tube holder. This holder often is a strap that fits around the head.

Sometimes the breathing tube is placed through a surgically made hole called a tracheostomy (TRA-ke-OS-to-me). The hole goes through the front of your neck and into your windpipe. The tube put into the hole sometimes is called a "trach" tube.

The procedure to make a tracheostomy usually is done in an operating room. Anesthesia is used, so you won't be awake or feel any pain. Specially made ties or bands that go around the neck hold the trach tube in place.

Both types of breathing tubes pass through your vocal cords and affect your ability to talk.

For the most part, endotracheal tubes are used for people who are on ventilators for shorter periods. The advantage of this tube is that it can be placed in an airway without surgery.

Trach tubes are used for people who need ventilators for longer periods. For people who are awake, this tube is more comfortable than the endotracheal tube. Under certain conditions, a person who has a trach tube may be able to talk.

The Ventilator

A ventilator uses pressure to blow air or a mixture of gases (like oxygen and air) into the lungs. This pressure is known as positive pressure. You usually exhale (breathe out) the air on your own, but sometimes the ventilator does this for you too.

A ventilator can be set to "breathe" a set number of times a minute. Sometimes it's set so that you can trigger the machine to blow air into your lungs. But, if you fail to trigger it within a certain amount of time, the machine automatically blows air to keep you breathing.

Rarely, doctors recommend a ventilator called a chest shell. This type of ventilator works like an iron lung—an early ventilator used by many polio patients in the last century. However, the chest shell isn't as bulky and confining as the iron lung.

The chest shell fits snugly to the outside of your chest. A machine creates a vacuum between the shell and the chest wall. This causes your chest to expand, and air is sucked into your lungs. No breathing tube is used with a chest shell.

When the vacuum is released, your chest falls back into place and the air in your lungs comes out. This cycle of vacuum and release is set at a normal breathing rate.

Ventilators normally don't cause pain. The breathing tube in your airway may cause some discomfort. It also affects your ability to talk and eat.

If your breathing tube is a trach tube, you may be able to talk. (A trach tube is put directly into your windpipe through a hole in the front of your neck.)

Instead of food, your health care team may give you nutrients through a tube inserted into a vein. If you're on a ventilator for a long time, you'll likely get food through a nasogastric, or feeding, tube. The tube goes through your nose or mouth or directly into your stomach or small intestine through a surgically made hole.

A ventilator greatly restricts your activity and also limits your movement. You may be able to sit up in bed or in a chair, but you usually can't move around much.

Patient on a Ventilator

The illustration shows a standard setup for a ventilator in a hospital room. The ventilator pushes warm, moist air (or air with increased oxygen) to the patient. Exhaled air flows away from the patient.

If you need to use a ventilator long term, you may be given a portable machine. This machine allows you to move around and even go outside, although you need to bring your ventilator with you.

Sometimes the ventilator is set so that you can trigger the machine to blow air into your lungs. But, if you fail to trigger it within a certain amount of time, the machine automatically blows air to keep you breathing.

Ongoing Care

While you're on a ventilator, your health care team will closely watch you. The team may include doctors, nurses, and respiratory therapists. You may need periodic chest x rays and blood tests to check the levels of oxygen and carbon dioxide (blood gases) in your body.

These tests help your health care team find out how well the ventilator is working for you. Based on the test results, they may adjust the ventilator's airflow and other settings as needed.

Also, a nurse or respiratory therapist will suction your breathing tube from time to time. This helps remove mucus from your lungs. Suctioning will cause you to cough, and you may feel short of breath for several seconds. You may get extra oxygen during suctioning to relieve shortness of breath.

Infections

One of the most serious and common risks of being on a ventilator is pneumonia. The breathing tube that's put in your airway can allow bacteria to enter your lungs. As a result, you may develop ventilator-associated pneumonia (VAP).

The breathing tube also makes it hard for you to cough. Coughing helps clear your airways of lung irritants that can cause infections.

VAP is a major concern for people using ventilators because they're often already very sick. Pneumonia may make it harder to treat their other disease or condition.

VAP is treated with antibiotics. You may need special antibiotics if the VAP is caused by bacteria that are resistant to standard treatment.

Another risk of being on a ventilator is a sinus infection. This type of infection is more common in people who have endotracheal tubes. (An endotracheal tube is put into your windpipe through your mouth or nose.) Sinus infections are treated with antibiotics.

Other Risks

Using a ventilator also can put you at risk for other problems, such as:

• Pneumothorax (noo-mo-THOR-aks). This is a condition in which air leaks out of the lungs and into the space between the lungs and the chest wall. This can cause pain and shortness of breath, and it may cause one or both lungs to collapse.
• Lung damage. Pushing air into the lungs with too much pressure can harm the lungs.
• Oxygen toxicity. High levels of oxygen can damage the lungs.

These problems may occur because of the forced airflow or high levels of oxygen from the ventilator.

Using a ventilator also can put you at risk for blood clots and serious skin infections. These problems tend to occur in people who have certain diseases and/or who are confined to bed or a wheelchair and must remain in one position for long periods.

Another possible problem is damage to the vocal cords from the breathing tube. If you find it hard to speak or breathe after your breathing tube is removed, let your doctor know.

"Weaning" is the process of taking you off of a ventilator so that you can start to breathe on your own. People usually are weaned after they've recovered enough from the problem that caused them to need the ventilator.

Weaning usually begins with a short trial. You stay connected to the ventilator, but you're given a chance to breathe on your own. Most people are able to breathe on their own the first time weaning is tried. Once you can successfully breathe on your own, the ventilator is stopped.

If you can't breathe on your own during the short trial, weaning will be tried at a later time. If repeated weaning attempts over a long time don't work, you may need to use the ventilator long term.

After you're weaned, the breathing tube is removed. You may cough while this is happening. Your voice may be hoarse for a short time after the tube is removed.