Download Artificial ventilation (ICU) - Derby Teaching Hospitals NHS

Visitors’
Information
Artificial ventilation
What is artificial ventilation?
Artificial ventilation refers to a machine
taking over all or some of a patient’s
breathing.
Who needs ventilating?
Intensive care patients may require
ventilation for a variety of reasons, and
include patients who have:
• Weakness of the nerves or muscles
• Damage to the ribs or chest wall
• Stiffness in the lungs due to a chest
infection
• Excess fluid in the lungs
• Obstruction of the airway as in
asthma or bronchitis
• After a major operation or one which
involves the face or neck.
While a patient is on a ventilator, it is
important to measure the amounts of
oxygen and carbon dioxide in the blood
(blood gases).
The results of these blood gases are
used to help the doctors decide what
treatment is required.
How is a patient ventilated?
The tube through which the patient is
ventilated is inserted through the nose
or mouth into the windpipe. This tube,
known as an endo-tracheal (E.T.) tube, is
then attached to the ventilator.
Some patients may have a tube in
their neck instead. This is known as a
tracheostomy and is used in the same
way as the E.T tube.
Even though a patient is on a ventilator,
this does not mean they are unable
to breathe. The ventilator has many
different settings and the patient is able
to do varying amounts of breathing
depending on their condition.
A sedated and
ventilated patient
Sedation and physiotherapy
In order to minimise discomfort and
tolerate ventilation, the patient may be
kept sedated.
The patient may remain ventilated for
hours, days or weeks depending on
their condition.
Through using the ventilator we are
able to control the amount of oxygen
given, the number and size of breaths,
and numerous other levels and pressures
within the lungs.
During this time, the nurses, doctors and
physiotherapists work together to clear
the lungs of secretions by physiotherapy
and suctioning while the body is being
supported by the ventilator.
Weaning
If their condition allows, it may be
possible to start weaning the patient
from the support of the ventilator. This
may take days or weeks to achieve.
The first step is to reduce the dose of
sedative. Everybody reacts differently
when coming round from sedation,
some wake quickly - within hours,
others take days. It is also common for
the waking patient to experience a
period of disorientation and confusion.
During the weaning process, the
amount of breathing assistance by the
ventilator is slowly reduced to enable
the patient to build up strength in the
respiratory muscles to enable him/her to
breathe unaided.
If the patient responds well to this
reduction in support, the doctor
may decide that the E.T. tube can be
removed. However, if the patient’s
respiratory muscles are not yet strong
enough to cope with the tube being
removed, then an ‘external circuit’ will
be used.
This circuit consists of oxygen tubing and
a valve giving support to the patient. It is
attached to the E.T. tube and makes the
patient work a little harder at breathing to
build up the muscles.
This may be done a few hours at a time
until the patient is able to tolerate staying
on the external circuit. It may then be
possible to remove the tube.
Discharge from the Intensive Care
Unit
Once the tube has been removed, the
patient usually still needs oxygen.
It is very important at this time, for
the patient to perform deep breathing
exercises and cough regularly. If not, then
the chest is at risk of deteriorating again
due to the build up of secretions.
If the patient is able to keep the chest
clear, transfer to a general ward may be
considered. This decision, however, is one
made by the Intensive Care Unit consultant
anaesthetist.
Acknowledgements for Illustrations
C J Hinds & D Waston (1996). Intensive Care. A Concise
Textbook, Second Edition, W B Saunders Company
Limited.
If you have any queries, or require further
information please do not hesitate to
speak to a member of staff.
www.derbyhospitals.nhs.uk
Trust Minicom 01332 254944
Any external organisations and websites included here do
not necessarily reflect the views of Derby Hospitals NHS
Foundation Trust, nor does their inclusion constitute a
recommendation.
Reference Code: G4428/0222/01.2001/VERSION1
© Copyright 2001. All rights reserved. No part of this
publication may be reproduced in any form or by any
means without prior permission in writing from the Patient
Information Service, Derby Hospitals NHS Foundation Trust.
Smoking is not permitted anywhere in the buildings
and grounds of Derby’s Hospitals. For advice and
support about giving up smoking please call
Free Phone 0800 707 6870.