VENTILATORS

MANASI S
CONTENTS
1. INTRODUCTION

2. HISTORY

3. HOW ARE VENTILATORS USED?

4. HOW DOES A VENTILATOR WORKS?

5. HOW LONG A VENTILATOR IS USED?

6. TYPES OF VENTILATORS

7. SETTING UP A VENTILATOR

8. VENTILATION MODES

9. ADVANTAGES OF VENTILATORS

10. HOW DOES A PATIENT FEEL WHILE ON A VENTILATOR

11. REFERENCES
INTRODUCTION
• A ventilator is a machine which is designed to mechanically move breathable air into and out of the lungs, to provide the mechanism of
breathing for a patient who is physically not able to breathe sufficiently.

HISTORY
• The use of ventilatory assistance can be traced back to biblical times. However, mechanical ventilators, in the form of negative-pressure
ventilation, first appeared in the early 1800s. Positive-pressure devices started to become available around 1900 and today's typical
intensive care unit (ICU) ventilator did not begin to be developed until the 1940s.

• The early history of mechanical ventilation begins with various versions of what was eventually called the 'iron lung', a form of non-
invasive negative pressure ventilator which was widely used in the Polio epidemics in the 20th century after the introduction of 'Drinker
respirator', in 1928, and the subsequent improvements introduced by John Haven Emerson in 1931.
WHY ARE VENTILATORS USED?

• To deliver high concentrations of oxygen into the lungs.

• To help get rid of carbon dioxide.

• To decrease the amount of energy a patient uses on breathing so their body can concentrate on fighting infection or recovering.

• To breathe for a person who is not breathing because of injury to the nervous system, like the brain or spinal cord, or who has very
weak muscles.

• To breathe for a patient who is unconscious because of a severe infection, build up of toxins, or drug overdose.

HOW DOES A VENTILATOR WORKS?

•When a person needs to be on a ventilator, a healthcare provider will insert an endotracheal tube (ET tube) through the patient’s nose or
mouth and into their windpipe (trachea). This tube is then connected to the ventilator.

•The endotracheal tube and ventilator do a variety of jobs. The ventilator pushes a mixture of air and oxygen into the patient’s lungs to get
oxygen into the body. The ventilator can also hold a constant amount of low pressure, called positive end-expiratory pressure (PEEP), in
order to keep the air sacs in the lung from collapsing. The endotracheal tube allows doctors and nurses to remove mucous from the
windpipe by suction.
• If a person has a blockage in the trachea, such as from a tumor, or needs the ventilator for a long period of time, then they may need a
tracheostomy procedure. During a tracheostomy, a surgeon makes a hole in the patient’s neck and trachea, then inserts a breathing tube
called a tracheostomy tube into the hole.

• The tracheostomy tube is then connected to the ventilator. A tracheostomy tube can stay in as long as needed, but does not have to be
permanent and can be removed if a patient no longer needs it. It is possible for a person to talk and eat with a tracheostomy tube.

• Most patients on a ventilator are monitored in an ICU. Anyone on a ventilator in an ICU setting will be hooked up to a monitor that
measures heart rate, respiratory rate, blood pressure, and oxygen saturation (“O 2 sats”). Other tests that may be done include chest-x-
rays and blood drawn to measure oxygen and carbon dioxide (“blood gases”).

• Members of the health care team (including doctors, nurses, respiratory therapists) will use this information to assess the patient’s status
and make adjustments to the ventilator if necessary.

HOW LONG A VENTILATOR IS USED?

• The health care team always tries to help a person get off the ventilator at the earliest possible time. “Weaning” refers to
the process of getting the patient off the ventilator. Some patients may be on a ventilator for only a few hours or days,
while others may require the ventilator for longer.
• How long a patient needs to be on a ventilator depends on many factors. These can include overall strength, how well their lungs were before
going on the ventilator, and how many other organs are affected (like the brain, heart and kidneys). Some people never improve enough to be
taken off the ventilator.

TYPES OF VENTILATORS
1. TRANSPORT VENTILATOR :- These are small and more rugged, and can be powered pneumatically or via AC or DC power sources.

2. INTENSIVE CARE VENTILATOR :- These are larger and usually run on AC power(though virtually all contain a battery to facilitate
intra-facility transport and as a back-up in the event of a power failure). It provides greater control of a wide variety of parameters. Many
ICU ventilators also provide visual feedback of each breathe through graphics.

3. NEONATAL VENTILATOR :- These are designed with the preterm neonate in mind, and are a specialized subset of ICU ventilators that
are designed to deliver the smaller, more precise volumes and pressures required to ventilate such patients.
4. POSITIVE AIRWAY PRESSURE VENTILATOR :- These are specifically designed for non-invasive ventilator, and can also be used at
home, e.g, for treating sleep apnea or COPD.

• It works by increasing the patient's airway pressure through an endotracheal or tracheostomy tube. The positive pressure allows the air to
flow into the airway until the ventilator breathe is terminated.

• Then the pressure drops to '0' and the elastic recoil of the lungs and chest wall push the tidal volume- breathe out through passive exhalation.

5. NEGATIVE AIRWAY PRESSURE VENTILATOR :- Here the air is withdrawn mechanically to produce a vacuum inside the tank, thus
creating negative pressure; which in turn leads to expansion of the chest.

• It leads to decrease in intra-pulmonary pressure, and increases flow of ambient air into the lungs.As the vacuum is released, the pressure
inside the tank equalises the ambient air pressure.

• The elastic coil of the chest and lungs thus leads to passive exhalation.
6. HIGH FREQUENCY VENTILATOR :- Frequency is from 60/min upto even 3000/min. It is of two types they are

• Jets:- It uses natural elastic recoil of the lungs, where expiration occurs passively.It consists of a applying high pressure jet to the airways
via a cannula or endotracheal tube.

• Oscillators:- It uses a reciprocating piston which aid expiration on its return stroke. Here expiration is active.

7. DIFFERENCIAL VENTILATION :- When a person has bilateral lung pathology, then this type of ventilation is used where two
synchronised ventilators are used simultaneously. It prevents ventilation -to-perfusion mismatch. Treatment cost is expensive as two ventilators
are required in one set-up.

SETTING UP THE VENTILATOR

• Vital signs- Pulse, Blood Pressure, Respiratory Rate, Heart Rate.Ensure adequate sedations, opioids and musclerelaxants.Tidal volume-
10ml/kg body weight.

• Fraction inspired oxygen: Usually 100% oxygen to start there decreases slow.

• Ensure the airway is secure.

VENTILATION MODES
ADVANTAGES OF VENTILATOR
• Better gas distribution.
• Lower mean airway pressure.
• Less Hemodynamic disturbance.
• Less sedation is required.
• Weaning is easier (in most of the cases).

HOW DOES A PATIENT FEEL WHILE ON A VENTILATOR?

• A person cannot talk when an ET tube passes between the vocal cords into the windpipe. He or she also cannot eat by mouth when this tube is in place.

• A person may feel uncomfortable as air is pushed into the lungs. Sometimes a person will try to breathe out when the ventilator is trying to push air in.

• This is working (or fighting) against the ventilator and makes it harder for the ventilator to help.

• People on ventilators may be given medicines (sedatives or pain controllers) to make them feel more comfortable. These medicines may also make
them sleepy. Sometimes, medications that temporarily prevent muscle movement (neuromuscular blocking agents) are used to allow the ventilator to
do all the work for the patient.

• These medications are typically used when a person has a very severe lung injury, they are stopped as soon as possible and always before ventilator
support is removed.
 REFERENCES

• https://www.slideshare.net/RajneeMishra/ventilator-61330983

• https://oxfordmedicine.com/view/10.1093/med/9780198784975.001.0001/me
d-9780198784975-chapter-8

• https://www.atsjournals.org/doi/10.1164/rccm.201503-0421PP

• https://www.thoracic.org/patients/patient-resources/resources/mechanical-ven
tilation.pdf
THANK YOU