What's a ventilator?

Dr Ryen, we’ve heard all about ventilator shortages in the last couple years. What exactly is a ventilator? And why is it so bad to go on one?

- Darlene, Roanoke, VA

Last week I got called to help with a sick patient in the Emergency Department. She was 26 years old and struggling to breathe. Over the last few days she’d gotten progressively more short of breath and fevered, to the point that she could barely maintain normal blood oxygen levels. What’s worse, she was getting tired - this poor woman simply could not keep up such an effort to breathe for much longer. Her chest X-ray showed extensive bacterial pneumonia. Essentially, her lungs were so full of bacteria, pus, and fluid that they weren’t able to transfer oxygen from the air and into her blood. In short, she was in respiratory failure. 

We prepared for an emergency intubation. Medications were given to put her to sleep and temporarily paralyze her. I carefully inserted a breathing tube through her mouth and down into her trachea (windpipe). Then we put her on a ventilator. This machine breathed for her. Every few seconds, it would push air through the breathing tube down into her lungs. We could control the oxygen content, the rate of breathing, the size of breaths, and (most importantly) the pressure of the airway circuit. Higher pressures helped to push much-need oxygen from her airways into her blood.

Despite her lungs failing, we put this very sick woman on a form of life support to give her body a chance (with antibiotics and other medications) to fight the infection in her lungs and recover. She was flown to a larger hospital with an Intensive Care Unit (ICU) that continued her treatment. Eventually, the hope was that she would gradually need less help from the ventilator and be able to breathe on her own. 

There are two common reasons to need a ventilator: severe disease-causing respiratory failure, and surgery. I often use a ventilator in the Operating Room, because the medications we give during a general anesthetic prevent patients from breathing adequately during the surgery. Typically, as soon as the anesthetic meds wear off, the patient breathes on their own, wakes up, and the breathing tube is pulled out. However, in cases of severe disease, patients may need to be on a ventilator for days or weeks on end. Some patients end up recovering. Others do not - their bodies are so sick that other organ systems fail and the patient dies, despite the best efforts of the medical staff.

So, to answer your question Darlene, a ventilator is simply a breathing machine. It buys sick people time to recover while medications or surgeries fix their problems. But it can’t fix the problems themselves. If someone needs a ventilator in an emergency, they are likely so sick that they’re on death’s door.

© D. B. Ryen Incorporated, September 2021.  

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