Ventilator/Ventilator Support

Also known as Mechanical Ventilator, Breathing Machine
Overview
The illustration shows a standard setup for a mechanical ventilator in a hospital room. The ventilator pushes warm, moist air (or air with extra oxygen) to the patient through a breathing tube (also called an endotracheal tube) or a tightly fitting mask.
The illustration shows a standard setup for a mechanical ventilator in a hospital room. The ventilator pushes warm, moist air (or air with extra oxygen) to the patient through a breathing tube (also called an endotracheal tube) or a tightly fitting mask.

You may be put on a mechanical ventilator if a condition makes it very difficult for you to breathe or get enough oxygen into your blood. This condition is called respiratory failure. Mechanical ventilators are machines that act as bellows to move air in and out of your lungs. Your doctor can set the ventilator to control how often it puts air into your lungs and how much air you get.

You may be fitted with a mask or helmet to get air from the ventilator into your lungs. Or you may need a breathing tube if your breathing problem is more serious. The endotracheal tube is inserted into your windpipe through your mouth or nose. Rarely, a tube may need to be placed through an opening in your neck (called a tracheostomy) either after a few days on the ventilator, or if the endotracheal tube is hard to place via your nose or mouth. You will not be able to talk or eat with an endotracheal tube. With a tracheostomy tube, you may be able to eat and talk with difficulty.

Mechanical ventilators are mainly used in hospitals and in transport systems such as ambulances and MEDEVAC air transport etc. In some cases, they can be used at home, if the illness is long term and the caregivers at home receive training and have adequate nursing and other resources in the home. Being on a ventilator may make you more susceptible to pneumonia, damage to your vocal cords, or other problems.

Explore this Health Topic to learn more about ventilators, our role in clinical trials, and where to find more information.

Who Needs a Ventilator? - Ventilator/Ventilator Support

You may need a ventilator in an emergency if a condition makes it difficult to breathe on your own (called respiratory failure). You may also need a ventilator during surgery.

You may need ventilation if you have serious lung or breathing problems or if you are having general anesthesia during surgery. Watch this video to learn more. Medical Animation Copyright © 2020 Nucleus Medical Media, All rights reserved.

Respiratory failure

Respiratory failure can be a life-threatening emergency. When you can’t breathe well, your organs cannot get enough oxygen to work. Too much carbon dioxide may also build up in your blood. This is a waste gas that is usually breathed out. Too much can damage your organs.

Many conditions and injuries can affect your breathing. Examples include:

Surgery

You may need a ventilator if you are going to have surgery with general anesthesia (medicine that makes you sleepy and stops you from feeling pain). The medicines used for anesthesia can affect your normal breathing. A ventilator helps control your breathing.

What to Expect Before You’re Put on a Ventilator - Ventilator/Ventilator Support

Ventilators are machines that blow air—or air with extra oxygen—into your airways and your lungs. Your airways are pipes that carry oxygen-rich air to your lungs when you breathe in. They also carry carbon dioxide (a waste gas) out of your lungs when you breathe out.

To learn more about your airways and lungs, visit our How the Lungs Work Health Topic.

The ventilator

A ventilator uses pressure to blow air—or air with extra oxygen—into your lungs. This pressure is known as positive pressure. You usually 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 is set so that the machine only blows air into your lungs when you need it to help you breathe.

Before your healthcare team puts you on a ventilator, they may give you:

  • Fluids and other medicines through your vein (via IV) to help keep oxygen-rich blood flowing to your organs
  • Medicines to make you sleepy and to stop you from feeling pain
  • Oxygen through a mask

There are several ways to get air from the ventilator into your lungs. You may wear a mask or helmet, or you may need a breathing tube.

Ventilation with a face mask or helmet

a man in a hospital bed on a ventilator
This image shows a face mask, which can deliver oxygen from a ventilator.

You may wear a face mask or helmet to get air from the ventilator into your lungs. This is called noninvasive ventilation. The face mask fits tightly over your nose and mouth to help you breathe. The helmet fits over your head. Your doctor may recommend this method if your breathing problems are not life-threatening or to help you get used to breathing on your own after your breathing tube is removed.

There are some benefits to this type of ventilation.

  • It can be more comfortable than a breathing tube.
  • It allows you to cough.
  • You may be able to talk and swallow.
  • You may need less sedative and fewer pain medicines.
  • It lowers some risks, such as pneumonia, that are associated with a breathing tube.

Ventilation with a breathing tube

In more serious cases or when non-invasive ventilation is not enough, you may need invasive ventilation. Here, a breathing tube is placed into your windpipe, and the breathing tube (also called an endotracheal tube) is connected to a ventilator that blows air directly into your airways. The process of putting the tube into your windpipe is called intubation.

Usually, the breathing tube is inserted into your nose or mouth. The tube is then moved down into your throat and your windpipe. The endotracheal tube is held in place by tape or a strap that fits around your head.

This procedure is often done in an operating room while you are under anesthesia. In emergencies outside the operating room, you will receive medicine to make you sleepy and prevent the pain and discomfort that occurs when a breathing tube is being inserted.

Watch this video to learn more about this process.

This animation shows how intubation works. Doctors use a special instrument to guide the endotracheal tube down through your mouth, down into your airways. Medical Animation Copyright © 2020 Nucleus Medical Media, All rights reserved.

If you need to be on a ventilator for a long time, the breathing tube will be put into your airways through a tracheostomy. Your doctor will use surgery to make a hole through the front of your neck and into your windpipe. The tube that is put into the hole is called a "tracheostomy" or “trach” tube. The tracheostomy procedure is usually done in an operating room or intensive care unit. Your doctor will use anesthesia, so you will not be awake or feel any pain. The trach tube is held in place by bands that go around your neck.

Both types of breathing tubes pass through your vocal cords. You can’t talk with an endotracheal tube and it will be difficult to talk with a trach tube unless it has a special speaking valve attachment. For the most part, endotracheal tubes are used for people who are on ventilators for shorter periods. If you need to be on a ventilator for a longer time, your doctor can replace the endotracheal tube with a trach tube, which is more comfortable for people who are awake.

What To Expect While on a Ventilator - Ventilator/Ventilator Support

Ventilators normally don't cause pain. The breathing tube in your airway may cause discomfort. It can also affect how well you eat and talk. You may be able to talk if you have a trach tube, face mask, or helmet.

A ventilator limits your movement, which may prevent you from carrying out your activities. When you are on the ventilator, your doctor may have you lie on your stomach instead of your back to help more of your lungs get oxygen.

While you're on a ventilator, your healthcare team will watch you closely. The team may include doctors, nurses, and respiratory therapists. You may need regular chest X-rays and blood tests to check the levels of oxygen and carbon dioxide in your body. These tests help your healthcare 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.

Ongoing care

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 improve shortness of breath.

Instead of food, your healthcare team may give you nutrients through a tube in your vein. Or you may get food through a feeding tube placed in either your nose or mouth that goes to your stomach. A tube may also be put through a surgically made hole in your abdomen that goes directly into your stomach or small intestine.

If you need a ventilator long term, you will get a tracheostomy and 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. You will need to take precautions not to displace your tracheostomy tube, or the tubing that connects it to your portable ventilator.

What Are the Risks of Being on a Ventilator? - Ventilator/Ventilator Support

Infections

One of the most serious and common risks of being on a ventilator is pneumonia. The breathing tube makes it hard for you to cough. Coughing helps clear your airways of germs that can cause infections. The breathing tube that is put into your airway can allow bacteria to enter your lungs. As a result, you may develop pneumonia.

Pneumonia is a major concern because people using ventilators are often already very sick. Pneumonia may make it harder to treat your other disease or condition. You may need special antibiotics, as the bacteria that caused your pneumonia could be resistant to standard antibiotics.

Another risk of being on a ventilator is a sinus infection. This type of infection is more common in people who have endotracheal tubes. Sinus infections are treated with antibiotics.

Other Risks

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

  • Atelectasis, a condition in which the lung does not expand fully. This causes the air sacs to collapse.
  • Blood clots. When using a ventilator, you may need to stay in bed or use a wheelchair. Staying in one position for long periods can raise your risk of blood clots and serious skin infections.
  • Fluid buildup in the air sacs inside your lungs, which are usually filled with air. This is called pulmonary edema.
  • Lung damage. Pushing too much air into the lungs or with too much pressure can harm your lungs. Too much oxygen can also damage your lungs. Babies put on a ventilator may be at a higher risk of lung infections or persistent lung problems as children and adults.
  • Muscle weakness. Using a ventilator decreases the work your diaphragm and other breathing muscles have to do, so they can become weak. This may lead to some problems and delays in being taken off the machine.
  • Pneumothorax. 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. It may cause one or both lungs to collapse.
  • Vocal cord damage. The breathing tube can damage your vocal cords. Tell your doctor if you have trouble speaking or breathing after your breathing tube is removed.

What to Expect When You're Ready to Be Taken Off a Ventilator - Ventilator/Ventilator Support

After most surgeries, your doctor will disconnect the ventilator once the anesthesia wears off and you begin breathing on your own. They will remove the tube from your throat. This usually happens before you completely wake up from surgery. When you wake up, you may not even know that 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.

Most people who have anesthesia during surgery only need a ventilator for a short time. However, you could stay on a ventilator for a few hours to several days after certain types of surgeries.

"Weaning" is the process of slowly decreasing ventilator support to the point when you can start breathing 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, you will be disconnected from the ventilator. Usually, people can be weaned when their doctor determines that they have recovered enough from the problem that caused them to need the ventilator.

You may cough while the breathing tube is removed. Your voice may be hoarse for a short time afterwards. If you can't breathe on your own during first attempt, 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.

If you continue to be critically ill and a ventilator does not help improve your condition, you may need extracorporeal membrane oxygenation (ECMO). ECMO passes your blood through a machine that adds oxygen, removes carbon dioxide, and pumps the blood back into your body. ECMO can be used for several days or weeks to give your lungs a chance to recover.

What to Expect When Going Home on a Ventilator - Ventilator/Ventilator Support

If you need to be on a ventilator for the long term and your condition is stable, you may be able to use a ventilator at home. This can help avoid some of the complications of long hospital stays and improve your quality of life. You will likely use the ventilator with a trach tube or face mask.

Some people need ventilator support for life. Other people may be able to stop using the ventilator when their condition improves. For example, your baby or child may be able to go home on a ventilator while they recover from a congenital heart defect or serious lung problem. Your doctor will decide whether you or your child is ready to stop using a ventilator.

Preparing to use a ventilator at home

Before you go home on a ventilator, your healthcare team will teach you and your caregivers how to:

  • Use and maintain your ventilator
  • Change your trach tube regularly, if you are using one, to remove mucus from your airways
  • Maintain the equipment needed to clear mucus and keep the airways open
  • Recognize when there is a serious problem and when to call your doctor or 9-1-1 for help

After the training, your healthcare team will watch as you and your caregivers do all the tasks necessary to take care of you at home. Sometimes, they will ask your loved ones to take care of you overnight at the hospital to make sure that you are all comfortable with using the ventilator.

You may be able to hire a trained healthcare professional to come to your house while you are on a ventilator.

Equipment for home ventilation

The type of ventilator that you may need may depend on your condition. Some ventilators are portable and can be used for short trips outside of the house. In addition, you may need:

  • A back-up ventilator and an extra oxygen tank, and possibly another type of oxygen therapy for emergencies
  • Batteries for your ventilator, in case you lose power suddenly or for short trips outside of the house
  • A suction machine to remove mucus from your airways
  • A humidifier to add moisture to the air to help you breathe better
  • A pulse oximeter to measure your blood oxygen levels
  • A nebulizer to give you medicines for breathing treatments

Using Your Ventilator at Home

It is very important that you and your caregivers follow your healthcare team’s instructions. No one should change the settings on your ventilator unless directed by your doctor. If your child is on a ventilator, a trained caregiver should be nearby and awake at all times. This may mean trading off caregiving or hiring a healthcare professional for nights.

You or a caregiver will need to check all equipment regularly to make sure that everything is working well. If you think that the ventilator is not working properly, call a professional to fix it.

You will also need to keep good records of any signs or symptoms that you may have while using the ventilator.

The following steps will help keep you or your child healthy while using a ventilator at home.

  • Keep close watch over the ventilator and respond quickly to alarms.
  • Wash your hands often to avoid spreading germs, and avoid people who are sick.
  • Avoid secondhand smoke. Cigarette smoke can cause life-threatening complications.
  • Get routine vaccines recommended by your doctor and stick to your treatment plan for any other medical condition that you may have.
  • Make sure your cellphone is charged at all times so you can call for help in an emergency.

Using a ventilator at home can be stressful for you and your loved ones. It is important that you ask for help and support whenever you need it. Read more and find resources for caregiver stress from the Office on Women’s Health.

Follow-up care

After you leave the hospital, your healthcare team will follow up regularly to make sure that your treatment is working well at home. This may include home visits by a respiratory therapist or a nurse who specializes in ventilator care. You may be able to take short trips to medical appointments if you use a portable ventilator.

Tell your electric and phone companies that someone in your household is on a ventilator. If your area loses service, these utility companies will try to restore service to your house as soon as possible. Your healthcare team can provide you with letters to send to your utility companies.

It is also helpful to keep a list of your health conditions, treatments, and medicines to give to first responders in case of an emergency.

Participate in NHLBI Clinical Trials

We lead or sponsor many studies relevant to ventilators. See if you or someone you know is eligible to participate in our clinical trials and observational studies.

Are you on a ventilator and do you want to test a device that makes sure you are lying in the best position?

If you are on a ventilator, it is important for doctors and nurses to put you in the right position to lower your chances of developing pneumonia. This study is testing a device that alerts doctors and nurses when you are not in the right position. To participate in this study, you must be ages 18-75 year and on a ventilator. This study is located in New York, New York.

Is your newborn in the NICU at Holtz Children’s Hospital in Miami?

Newborns born very prematurely often need oxygen therapy or ventilation to help them breathe and survive. This study will help doctors understand how changes in oxygen and carbon dioxide levels while newborns are getting treatment affect how their lungs develop. While your newborn is in the newborn neonatal intensive care unit (NICU), researchers will record his or her oxygen and carbon dioxide levels, heart rate, and other measures. To participate in this study, your newborn must have been born prematurely between 23 and 28 weeks’ gestation, be less than 28 days old, and be receiving oxygen therapy. This study is located in Miami, Florida.

Is your newborn receiving care at the University of Alabama at Birmingham Women and Infants Center?

This study is testing new ways to help control breathing and oxygen and carbon dioxide levels in premature newborns. To participate in this study, your premature newborn must be in the neonatal intensive care unit or the critical care nursery at the Birmingham Women and Infants Center at the University of Alabama. This study is located in Birmingham, Alabama.

Is your child on a ventilator for acute respiratory distress syndrome (ARDS)?

This study is testing whether lying facedown and using a type of ventilation called high-frequency oscillatory ventilation improves breathing in children who have ARDS. To participate in this study, your child must be younger than age 18, diagnosed with ARDS, and on a ventilator. This study is located in 23 states in the United States, as well as in Australia, Canada, the Netherlands, and Thailand.

Is your child on a ventilator at Children’s Hospital Los Angeles?

Ventilators can sometimes weaken the muscles around the lungs, especially in children. This study is testing whether a new computer method to control ventilators can help prevent muscle weakness in children. To participate in this study, your child must be between 1 month and 18 years old and have been on a ventilator for less than 48 hours (or 72 if they were transferred from another hospital) because of a serious lung disease. This study is located in Los Angeles, California.

Are you or a loved one on a ventilator in the hospital in Minnesota?

This study is finding out whether people who are on a ventilator sleep better and have less anxiety if they can control their own sedation medicine. To participate in this study, you must be at least 18 years old and receiving mechanical ventilation while hospitalized. This study is located in Minneapolis and Rochester, Minnesota.

More Information

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