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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.