Glimmer of Hope
Intro: A precious tool in critical care physician’s hand, a ventilator is a life-saving and respiratory support and does not augur the end of life
Life is uncertain and in unexpected circumstances, anyone can end up on life support. While being on a ventilator is usually perceived as the end of life, it is just not true. Ventilator is an essential life support which every doctor and hospital gives to save the life of a patient and not to end life.
Necessity of Ventilation
Ventilator is a life-saving and respiratory support. Various parameters of a patient are checked before being put on ventilation. Doctors use other tools like non-invasive ventilation, high flow nasal oxygen therapy first to avoid a ventilator. It is only when those measures fail and respiratory status continues to deteriorate that a ventilator is brought in.
It depends on the primary condition of the patient. In case of a patient suffering from Pneumonia, the ventilator gives the lungs rest. It is similar to dialysis to help the kidneys. Ventilator takes care of respiration and once the primary problem is resolved, the patient is taken out of the ventilator. In post-operative cases when lungs are weak, ventilator is given for support of the lungs. It could be for just a day. However, bad lungs, less muscle power may require prolonged ventilation.
Weaning Off Ventilation
It is a protocol driven thing. The process starts from the very day a patient is put on ventilation. Oxygen support as well as pressure on the ventilator is decreased to see how a patient is adapting. There are some international criteria and once the patient satisfies those, s/he is taken off ventilator.
While on V, what complications can be arise
The ventilator tube is directly attached to trachea. Disconnection or less oxygen delivery can cause oxygen deprivation and serious trouble to patient, even cardiac arrest. Ventilator-associated pneumonia (VAP) is the most common infection as the tube is a foreign device. The precautionary measures are called ventilator precaution bundle.
Precautions To Take
Ventilator is a dual instrument. In the initial days, it gives support and rest to the lungs. But prolonged use can cause multiple problems like ventilator associated infection as it is an invasive foreign device in the body. The breathing tube that is put in the trachea can allow bacteria to enter lungs. Oral hygiene care together with aspiration of secretions and upright posture may reduce the risk of ventilator complications.
Neurological patients often need prolonged ventilation. In such cases, smaller sized tubes are inserted in trachea through which ventilation is delivered. On and off ventilation is also practised. In initial period, a tube is inserted in the oral cavity. When it cannot be taken out 7-10 days later, a smaller size tube is put in through a small procedure known as tracheostomy. It is better than having the big tube in the oral cavity. Such patients can also be discharged after a tracheostomy, provided they require no special medicine support. Nursing care is a must.
Tracheostomy patients who do not require ventilation are unconscious. Patients with paralysis, neurological problems or other conditions find it difficult to cough up secretions; so direct suctioning of the trachea is done to clear the airway. Post this, they can go home. Mini ventilators can also be arranged at home when only respiratory support and no other support is needed.
Ventilator has been changing since invention. Modernised ventilators require less medicines and dose of anaesthesia. Ventilator synchronisation is much better now. Besides there are new gadgets like non-invasive ventilation that does not require tubes to be put in and high flow nasal oxygen therapy. A dead person cannot be put on ventilator and unlike what is shown in some movies, it cannot revive one who is dead.