Medical Ventilators: Types, Uses and How They Function

Mechanical ventilators assist patients who can't breathe on their own due to various health conditions. They deliver oxygen to the lungs and remove carbon dioxide. Mechanical ventilators are carefully monitored by medical professionals to ensure patient well-being. Prolonged use can lead to complications like pneumonia and muscle atrophy, affecting long-term mobility and quality of life. Ventilator weaning is the process of transitioning patients to independent breathing once they've recovered.

What are the different types of ventilators?

Ventilators come in different types, offering varying levels of support based on the patient's condition. They are crucial in medical settings, including hospitals and ambulances, and can also be used for long-term ventilation at home.

• Face mask ventilators: These are non-invasive and use a mask to deliver air or oxygen to the patient's airway.
• Mechanical ventilators: These are invasive and work via tubes inserted through the patient's mouth or nose into the windpipe (intubation).
• Manual resuscitator bags: These are hand-operated devices used to provide positive pressure ventilation.
• Tracheostomy ventilators: These are invasive and use a surgically created hole in the neck leading to the trachea for ventilation.

Face mask ventilator:

Face mask ventilators are non-invasive devices that help people with breathing difficulties, especially those with conditions like COVID-19 or chronic respiratory issues. They work by delivering air into the airways and lungs through a mask covering the nose and mouth. These ventilators can also be used for continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) therapy, which is beneficial for various chronic respiratory conditions. The choice between CPAP and BiPAP depends on the specific needs and condition of the patient.

Advantages:

• They do not require intubation, making them less invasive and more comfortable for the patient.
• They help in maintaining oxygen levels and expelling carbon dioxide effectively.
• Some patients can use CPAP and BiPAP devices at home, reducing the need for prolonged hospitalization.

Disadvantages:

• They may not provide the same degree of precise control over ventilation as mechanical ventilators.

• Some patients may find it uncomfortable to wear a mask for extended periods.
• In severe cases, especially in critical care settings, mechanical ventilation through intubation may be more effective.
• CPAP and BiPAP machines can be noisy and cause discomfort to some users.

Mechanical ventilator:

Mechanical ventilators are devices employed when an individual is incapable of independent breathing. They function through a tube inserted into the patient's airway, delivering air to the lungs and removing carbon dioxide. The ventilation unit adjusts air pressure, humidity, volume, and temperature based on healthcare professionals' settings. These machines are essential for individuals in critical conditions, such as severe cases of COVID-19

Advantages:

• Mechanical ventilators completely take over the breathing process, providing comprehensive support to patients who cannot breathe on their own.
• Healthcare professionals can precisely control various ventilation parameters, ensuring customized care.
• Mechanical ventilators are essential in critical care situations, such as severe COVID-19 cases. They offer various modes to adapt to specific patient needs.

Disadvantages:

• Mechanical ventilation requires the insertion of a tube into the patient's airway, which is an invasive procedure.
• Intubation carries risks of complications, including infection, injury to the vocal cords, and ventilator-associated pneumonia.
• Patients may find intubation uncomfortable and may require sedation.
• Prolonged mechanical ventilation can lead to respiratory muscle atrophy and long-term disability.

Invasive mechanical ventilation:

Invasive mechanical ventilation requires the insertion of an endotracheal tube through a patient's mouth or nose into the trachea, the upper part of the airway leading to the lungs. This tube is connected to a machine that administers a predetermined oxygen concentration, air volume, and a specific number of breaths per minute. These settings are adapted to match the patient's oxygen and carbon dioxide levels. Patients with acute illnesses in need of invasive mechanical ventilation should receive intensive care unit monitoring.

Non Invasive Ventilation:

Non-invasive ventilation (NIV) is a method of providing breathing support without using invasive artificial airways. It has become a crucial tool for managing acute and chronic respiratory failure, both in hospitals and at home. NIV can replace or complement invasive ventilation, especially in cases of acute respiratory failure. While its role in chronic respiratory failure is less defined, its application in acute situations is well-established.

Manual resuscitator bags:

Manual resuscitator bags are devices that allow individuals to manually control the airflow to a ventilator. These bags consist of a flexible bladder that can be squeezed to deliver air into the patient's lungs. They can be connected to a face mask ventilator or directly to an endotracheal tube in a person's throat. Manual resuscitator bags are especially useful as a temporary solution when a person on mechanical ventilation needs to temporarily stop using the machine, such as during a power outage.

Advantages:

• Manual resuscitator bags allow for quick and immediate ventilation support when needed, such as during ventilator failure or transport.
• They are compact and portable, making them suitable for use in various settings, including during ambulance transport.
• Medical professionals can control the ventilation process manually, adjusting the rate and volume of breaths.
• They serve as a reliable backup in case of mechanical ventilator failure or power outages.

Disadvantages:

• The effective use requires training and skill, as improper use can lead to complications.
• Sustained manual ventilation can be physically demanding for healthcare providers.
• Manual resuscitators lack the monitoring capabilities of mechanical ventilators, potentially making it challenging to maintain precise oxygen and carbon dioxide levels.
• There's a risk of overventilation or hyperventilation, which can have adverse effects on patients.

Tracheostomy ventilator:

People who have undergone a tracheostomy, a surgical procedure creating an opening in the windpipe, often require ventilator support. This allows them to breathe directly through the tracheostomy tube inserted into the windpipe. Tracheostomies are typically needed for extended mechanical ventilation, rehabilitation, or due to chronic respiratory conditions or neuromuscular disorders that affect breathing muscles.

Advantages:

• Provides direct and stable airway access for long-term ventilation.
• Reduces the risk of complications associated with endotracheal intubation.
• Improves patient comfort and speech when managed appropriately.

Disadvantages:

• Requires a surgical procedure.
• Increased risk of infection and tracheostomy-related complications.
• Requires diligent care and maintenance.

Who needs a Ventilator?

People require ventilation when experiencing respiratory failure, which can be life-threatening and is caused by various injuries and conditions such as:

• Head injuries
• Strokes
• Lung diseases
• Sudden cardiac Arrest
• Neonatal respiratory distress syndrome
• Acute respiratory distress syndrome (ARDS)
• Pneumonia
• Many more

Ventilators are also used for patients undergoing surgery who are temporarily unable to breathe independently due to anaesthesia. In the context of COVID-19, severe difficulty breathing may require ventilator support in critically ill cases.

Tips to follow while using Ventilator:

• Caring for a ventilator patient requires strict adherence to guidelines and care protocols:
• If you're unsure about ventilator equipment or settings, consult a medical professional. Only trained individuals should handle the machine.
• Regularly check oxygen saturation, breathing sounds, anxiety levels, pain, and observe any changes from previous assessments. Stay vigilant with all ventilator modes.
• Patients with nasotracheal tubes may require suction. Ensure proper suction techniques and avoid instilling normal saline solution into the endotracheal tube.
• Ventilator patients can't communicate discomfort. Use a reliable pain scale to gauge pain levels and take appropriate actions to alleviate it.
• Position the patient with the head elevated at 30-35 degrees to enhance comfort.
• Prevent hemodynamic instability by regularly monitoring blood pressure (every 2-4 hours). If it rises significantly, consider seeking medical assistance.
• Educate the patient's family about ventilator operation and safety precautions. Ensure that only trained professionals handle the equipment.