Ventilator/Ventilator Support What to Expect

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Ventilators are machines that blow air into your airways and your lungs. Your airways are pipes that carry oxygen-rich air to your lungs when you breathe in. They also carry carbon dioxide (a waste gas) out of your lungs when you breathe out.

A ventilator can be set to "breathe" a set number of times a minute. Sometimes it is set so that the machine only blows air into your lungs when you need it to help you breathe.

Before your healthcare team puts you on a ventilator, they may give you:

• Oxygen through a mask
• Medicines to make you sleepy and to stop you from feeling pain
• Fluids and other medicines through your vein (IV) to help keep oxygen-rich blood flowing to your organs.

There are two ways to get air from the ventilator into your lungs. You may wear a mask, or you may need a breathing tube.

You may wear a face mask to get air from the ventilator into your lungs. This is called noninvasive ventilation. The face mask fits tightly over your nose and mouth to help you breathe. Your doctor may recommend this method if your breathing problems are not yet severe enough for you to need a breathing tube or to help you get used to breathing on your own after your breathing tube is removed.

There are some benefits to this type of ventilation.

• It can be more comfortable than a breathing tube.
• It allows you to cough.
• You may be able to talk and swallow.
• You may need less sedative and pain medicines.
• It lowers some risks, such as pneumonia, that are associated with a breathing tube.

In more serious cases or when non-invasive ventilation is not enough, you may need invasive ventilation. Here, a breathing tube is placed into your windpipe, and the breathing tube (also called an endotracheal tube) is connected to a ventilator that blows air directly into your airways. The process of putting the tube into your windpipe is called intubation.

Usually, the breathing tube is inserted into your nose or mouth. The tube is then moved down into your throat and your windpipe. The endotracheal tube is held in place by tape or a strap that fits around your head.

For surgery, this procedure is done in the operating room after you are sedated (given medicine to make you sleep). In emergencies outside the operating room, you will receive medicine to make you sleepy and prevent the pain and discomfort that occurs when a breathing tube is being inserted.

Watch this video to learn more about this process.

If you need to be on a ventilator for a long time, the breathing tube will be put into your airways through a tracheostomy. Your doctor will use surgery to make a hole through the front of your neck and into your windpipe (trachea). The hole is called a "tracheostomy" and the tube a “trach” tube. The tracheostomy procedure is usually done in an operating room or intensive care unit. Your doctor will use anesthesia, so you will not be awake or feel any pain. The trach tube is held in place by bands that go around your neck.

Both types of breathing tubes pass through your vocal cords. You can’t talk with an endotracheal tube and it will be difficult to talk with a trach tube unless it has a special speaking valve attachment. For the most part, endotracheal tubes are used for people who are on ventilators for shorter periods. If you need to be on a ventilator for a longer time, your doctor can replace the endotracheal tube with a trach tube, which is more comfortable for people who are awake.

Being on a ventilator is not usually painful but can be uncomfortable. With a breathing tube, you will not be able to eat or talk. With a trach tube, you may be able to talk with a special device and eat some types of food. With a face mask, you will be able to talk and eat only if recommended by your healthcare team.

Being on a ventilator limits your movement and could also keep you in bed. When you are on the ventilator, your doctor may have you lie on your stomach instead of your back to help the air and blood flow in your lungs more evenly and help your lungs get more oxygen.

While you're on a ventilator, your healthcare team, including doctors, respiratory therapists, and nurses, will watch you closely. You may need regular lung imaging tests and blood tests to check the levels of oxygen and carbon dioxide in your body. These tests help your healthcare team find out how well the ventilator is working for you and help make sure that the breathing tube stays in a safe position in your windpipe. Based on the test results, they may adjust the ventilator's airflow and other settings as needed.

A respiratory therapist or nurse will suction your breathing tube from time to time. This helps remove mucus from your lungs. Suctioning will cause you to cough, and you may feel short of breath for several seconds. You may get extra oxygen during suctioning to improve shortness of breath.

Instead of food, your healthcare team may give you nutrients through a tube in your vein. Or you may get nutrition through a feeding tube placed in your nose or mouth to your stomach. A tube may also be put through a surgically made hole in your abdomen that goes directly into your stomach or small intestine.

If you need a ventilator long term, you will get a tracheostomy, and you may be given a portable machine. This machine allows you to move around and even go outside, although you need to bring your ventilator with you. You will need to take precautions not to displace your tracheostomy tube, or the tubing that connects it to your portable ventilator.

After most surgeries, your healthcare team will disconnect the ventilator once the anesthesia wears off and you begin breathing on your own. They will remove the tube from your throat. This usually happens before you completely wake up from surgery. When you wake up, you may not even know that you were connected to a ventilator. The only sign may be a slight sore throat for a short time. The sore throat is caused by the tube placed in your airway that connects to the ventilator.

Most people who have anesthesia during surgery need a ventilator for only a short time. However, you could stay on a ventilator for a few hours to several days after certain types of surgeries.

"Weaning" is the process of slowly decreasing ventilator support to the point when you can start breathing on your own. Most people can breathe on their own the first time weaning is tried. Once you show that you can successfully breathe on your own, you will be disconnected from the ventilator. Usually, people can be weaned when their healthcare team determines that they have recovered enough from the problem that caused them to need the ventilator and that they would likely be able to breathe on their own.

You may cough while the breathing tube is being removed and have a sore throat and a hoarse voice for a short time afterward. If you can't breathe on your own during a controlled test, weaning will be tried later. If repeated weaning attempts over a long time don’t work, you may need to use the ventilator long term.

If you continue to be critically ill and a ventilator does not help improve your condition, you may need extracorporeal membrane oxygenation (ECMO). ECMO passes your blood through a machine that adds oxygen, removes carbon dioxide, and pumps the blood back into your body. ECMO can be used for several days or weeks to rest your lungs and give them a chance to recover. You will still be on a ventilator but at lower pressures, so the ventilator does not damage your lungs any further.