What is a ventilator? Everything about it in simple terms (Mechanical Ventilation)

You've probably been to see someone in the intensive care unit (ICU). Or at least you've seen a movie where a patient is hooked up to a machine with a tube in their mouth. You might have felt a little scared or curious when you saw that. One of the most important of those machines is the ventilator. Although many people are afraid of it, it is actually a life-saving device. So today, let's talk about what a ventilator, or in medical terms, ``Mechanical Ventilation'' is, why it is needed, and everything related to it in a very simple way.

Simply put, what is a ventilator?

A ventilator is a machine that helps you breathe, or takes over the task entirely, when you can't breathe on your own. Just as crutches support your weight when you have a broken leg, a ventilator supports your lungs.

This machine does three main things:

• It provides your lungs with the oxygen they need.
• It helps your lungs remove unwanted carbon dioxide that accumulates in your body.
• The tiny air sacs (alveoli) inside your lungs provide the pressure needed to keep them open without collapsing.

Doctors can adjust the settings of this machine to suit your condition and provide you with the support you need.

Are "Intubation" and "Ventilation" two different things?

Yes, although these two often occur together, this refers to two processes.

• Intubation: This is when a doctor inserts a tube through your mouth or nose, down your windpipe (trachea) and into your lungs. This is also called an ``endotracheal tube`` or ET tube.
• Mechanical Ventilation: This refers to the process of connecting the previously inserted tube to a ventilator machine, which helps you breathe.

Sometimes, instead of inserting a tube like this, you can connect to the ventilator through a face mask that fits tightly over your face. We'll talk about that in a bit.

What are the main types of ventilator therapy?

Ventilators used today use positive pressure to force air into the lungs. This can be done in two main ways.

When is a ventilator needed?

You may need the help of a ventilator in any serious situation where you can't breathe properly on your own. For example:

• During major surgery: When you are under general anesthesia, your ability to breathe is reduced. Therefore, you will be given the assistance of a ventilator during the surgery.
• Serious lung infections or conditions: Pneumonia, COVID-19, Acute Respiratory Distress Syndrome (ARDS), and Chronic Obstructive Pulmonary Disease (COPD) when conditions worsen.
• Emergency or medical conditions: Any emergency that blocks the airway and makes breathing difficult. For example, a severe allergic reaction (anaphylaxis).
• Brain damage or disease: In cases such as stroke and traumatic brain injury, the brain is unable to properly send signals to the lungs to breathe.
• Changes in blood gas balance: If the amount of carbon dioxide in the blood increases (hypercapnia) or the amount of oxygen decreases (hypoxemia), a ventilator is needed to control this condition.
• Protect the airway: If a person is unconscious (coma), saliva or food that is in their mouth can enter the lungs if they vomit. To prevent this, an aspiration tube is inserted to protect the airway.

How long will you have to be on a ventilator?

This depends entirely on the condition that caused you to need a ventilator. It could be a few hours, a few days, a few weeks. In very rare cases, you may have to stay for months or even years. The goal of the medical team is to get you off the ventilator as quickly and safely as possible . Until then, they will monitor your condition regularly.

Typically, if it appears that you will need to be on a ventilator for more than two weeks, doctors will remove the tube in your mouth and insert a tube through a small incision in your neck (tracheostomy). This is a more comfortable and long-term method for the patient.

What happens when you connect it to a ventilator?

This process takes place in an intensive care unit (ICU).

1. First, you will be given sedation to help you relax and feel sleepy. At the same time, you will be given a paralytic to keep your body from moving while the tube is inserted.

2. Then a doctor inserts a tube (ET tube) through your mouth into your windpipe.

3. Finally, the tube is connected to the ventilator machine. Then the machine starts breathing for you.

In an emergency, this may have to be done in a slightly different way, very quickly.

What else happens when you're on a ventilator?

While you're on a ventilator, you'll be cared for by a specially trained team of doctors. There are a few additional things that happen during this time.

Close monitoring

You will be connected to other monitors to monitor your body's activity.

• Blood pressure
• Heart rate
• Respiratory rate
• Oxygen levels in the blood

These things are monitored regularly. Chest X-rays are also done to check the condition of the lungs and blood tests are done to check the oxygen levels in the blood.

Suctioning

The breathing tube can cause mucus to build up in your airway. So, nurses often insert another thin tube (catheter) into the tube to remove the mucus that builds up. You may cough a little and feel uncomfortable during this time. This can be a bit uncomfortable for onlookers, but it is essential to keep your airway clear.

Nutrition

You cannot eat or drink because you have a tube in your mouth. Therefore, you will be given liquid nutrition through a thin tube that goes from your nose to your stomach. Other fluids will be given through a saline solution into a vein.

Mobilization

Since it's not good to stay in bed all the time, the medical team will keep you moving. Sometimes, if you're in a position to do so, they'll even try to get you to walk around a bit.

What are the benefits and risks?

Like any medical treatment, ventilator treatment has both benefits and risks.

What are PEEP and CPAP?

You've probably heard both of these words.

• PEEP (Positive End-Expiratory Pressure): This is a setting on a ventilator machine. In some medical conditions, when we exhale, the air sacs in the lungs (alveoli) completely close. The PEEP setting keeps those air sacs open by applying a small amount of pressure even when you exhale. This increases the amount of oxygen that gets into the blood.
• CPAP (Continuous Positive Airway Pressure): This involves continuously delivering the same amount of positive pressure to the airways while breathing in and out. It is often used for conditions such as sleep apnea, as a non-invasive ventilation method (through a mask).

Simply put, PEEP is the pressure applied to a patient on a ventilator as they exhale. CPAP is a continuous pressure applied during both inhalation and exhalation.

A ventilator is a vital piece of equipment that can save your life in the event of a serious illness or emergency. While it doesn't cure the disease, it gives your body the time and support it needs to fight the disease and recover.