As medical advancements continue to increase survival rates and extend life for critically ill or injured patients, the number of ventilator-dependent patients continues to increase. Trying to make sense of what to expect for a ventilator-dependent patient can feel overwhelming. These five facts will help you take it all in.
A ventilator is a life-support machine that helps a patient breathe when they are unable to breathe on their own. A mechanical ventilator delivers oxygen through a tube inserted into the airway, pushing the air into the lungs at high flow and usually higher-than-normal pressures so that oxygen can reach the blood.
The most common use of a ventilator is during surgical procedures requiring general anesthesia. The surgery patient is unaware of the ventilator, and the tube is most often removed before the patient wakes from sedation.
Ventilators may also be necessary after serious injury or illness during in-hospital recovery. In these cases, the ventilator-dependent patient will be in an intensive care unit (ICU) and ventilator use is expected to be short-term. In cases of critical accident or injury, a patient is sometimes kept sedated to give the body time to heal and will remain vented during the period of sedation—often referred to as an induced coma.
Sometimes complications, such as direct injury to lungs and pulmonary function or chronic or underlying illness, may require prolonged mechanical ventilation (PMV). PMV patients are usually awake during their recovery period. They will be weaned from mechanical breathing assistance as their condition improves. The ventilator will be removed when they can breathe on their own.
When possible, depending on the severity of any illness or injury and the expected term of ventilation therapy, prolonged ventilator patients may be moved out of ICU to a room with a portable ventilator unit. They will be able to sit up in bed or in a chair and move about the room.
Long-term mechanical ventilation (LTMV) generally means all attempts to wean the patient from the ventilator machine have been unsuccessful and there is no expectation of improvement or possibility of unassisted breathing in the future. The LTMV patient is expected to live the rest of their life using a ventilator.
LTMV can prolong the patient’s life in cases of paralysis or chronic and progressive lung disease in late stages. The ventilator is used only to support life; it does not treat the disease or condition.
In the hospital, short-term ventilation patients are vented by intubation, the insertion of an endotracheal tube into the windpipe through the nose or mouth. The tube is held in place with a strap around the head and/or tape used in the nose and mouth area. There is little or no pain, even for PMV patients who are awake. If awake, the patient will not be able to talk or eat by mouth.
A long-term ventilator-dependent patient will almost always have a tracheotomy (trach) tube—a vent tube placed surgically through an incision at the front of the neck into the trachea, or windpipe. Trach tubes are inserted while the patient is sedated but are used for people who will be awake. Bands going around the neck hrmally. However, swallowing food or liquid may feel different.
The portable ventilator makes it possible for the long-term ventilator-dependent patient to live outside the hospital—either in care facilities or at home, though the expense of equipment and skilled care providers most often makes living at home cost prohibitive. Portable ventilators also offer greater mobility for LTMV patients, helping them lead fuller and richer lives.
A ventilator-dependent patient requires a care team of doctors, nurses, and respiratory therapists. Other helpful services include mental health therapy, physical therapy, and speech therapy to help with vocalizing, eating, and swallowing. The breathing tube must be suctioned as necessary. This causes coughing and brief shortness of breath. A personal care assistant, or family caregiver, will assist with the patient’s daily personal routines, such as bathing and dressing.
Periodic chest x-rays and blood tests to monitor levels of blood gasses are necessary. These tests help the health care team determine how well the ventilator is working for the patient. Based on the results, the ventilator can be adjusted for concentration, air flow, and pressure, as needed.
Ventilator-associated pneumonia is the most serious risk of long-term ventilator use. The breathing tube provides an open pathway for bacteria to enter the lungs. It also makes coughing difficult, and coughing is the body’s way of expelling irritants from the lungs and airway that may otherwise cause infection.
Sinus infections are another risk for a ventilator-dependent patient, though more common with endotracheal intubation. There is a lower incidence of sinus infection with use of a trach tube. Both pneumonia and sinus infections are treated with antibiotics.
Long-term use of a ventilator also carries the risk of pneumothorax, air leaking from the lungs into the space between the lungs and the chest wall. Pneumothorax can cause one or both lungs to collapse.
Blood clots and serious skin infections pose another risk, though both tend to occur in people who have certain diseases or are confined to bed or a wheelchair.
Too much pressure and/or oxygen levels that are set too high can damage the lungs. Careful regular monitoring of ventilator levels helps prevent this risk.
Better Options Ventilator Specialty Care offers quality, expert care for long-term ventilator patients in a home-like setting. We provide whole-patient care that encourages engagement and independence. Contact us to learn more.