A ventilator is a device that supports or takes over the breathing process, pumping air into the lungs. People who stay in intensive care units (ICU) may need the support of a ventilator. This includes people with severe COVID-19 symptoms.
Before COVID-19 became a pandemic, a need for ventilation was one of the most common reasons people received treatment in ICUs. Since then, the demand for ventilators has increased.
In this article, we will look at what ventilators are, the reasons people need them, different types, and the recovery process.
A ventilator is a device that supports or recreates the process of breathing by pumping air into the lungs. Sometimes people refer to it as a vent or breathing machine.
Doctors use ventilators if a person cannot breathe adequately on their own. This may be because they are undergoing general anesthesia or have an illness that affects their breathing.
There are different types of ventilator, and each provides varying levels of support. The type a doctor uses will depend on the person’s condition.
Ventilators play an important role in saving lives, both in hospitals and ambulances. People who require long-term ventilation can also use them at home.
People require ventilation if they are experiencing respiratory failure. When this occurs, a person cannot get enough oxygen and may not be able to expel carbon dioxide very well either. It can be a life-threatening condition.
There are many injuries and conditions that can cause respiratory failure, including:
- head injury
- lung disease
- spinal cord injury
- sudden cardiac arrest
- neonatal respiratory distress syndrome
- acute respiratory distress syndrome (ARDS)
Some people with COVID-19 have severe difficulty breathing, or develop ARDS. However, this only occurs in people who become critically ill, which accounts for around 5% of all confirmed COVID-19 cases.
In addition, doctors also use ventilators for people who undergo surgery and will not be able to breathe on their own due to anesthesia.
There are several ways a person can receive ventilator support. These include:
- face mask ventilators
- mechanical ventilators
- manual resuscitator bags
- tracheostomy ventilators
Face mask ventilators are noninvasive, while mechanical and tracheostomy ventilators are invasive and work via tubes that a doctor inserts into the throat. This is known as intubation.
For some, a face mask ventilator may be sufficient to stabilize their condition. People who physically struggle to breathe independently may require mechanical ventilation.
Below, we look at each type of ventilator and how they work.
Face mask ventilator
A face mask ventilator is a noninvasive method of supporting a person’s breathing and oxygen levels. To use one, a person wears a mask that fits over the nose and mouth while air blows into their airways and lungs.
People with COVID-19 may use a face mask ventilator if they are having difficulty breathing or do not have sufficient oxygen levels.
Continuous positive airway pressure and bilateral positive airway pressure devices also operate via a face mask. People often use these for chronic conditions such as chronic obstructive pulmonary disease, but some doctors may also use them for people with COVID-19.
Mechanical ventilators are machines that take over the breathing process entirely. Doctors use these when a person cannot breathe on their own.
Mechanical ventilators work via a tube in a person’s throat, pumping air into the lungs and transporting carbon dioxide away. A ventilator unit regulates the pressure, humidity, and temperature of the air. This allows healthcare professionals to control a person’s breathing and oxygen levels.
People with COVID-19 may need a mechanical ventilator if they are critically ill.
Manual resuscitator bags
Manual resuscitator bags are pieces of equipment that allow people to control the airflow of their ventilator with their hands. These devices consist of an empty bag, or “bladder,” that a person squeezes to pump air into the lungs.
A person can attach one of these devices to a face mask ventilator, or, if they are intubated, a doctor can attach one to the tube in their throat.
This can be useful as a temporary solution if a person on a mechanical ventilator needs to stop using it. For example, if there is a power outage, a person can use a manual resuscitator bag while waiting for the power to come back on.
People who have undergone a tracheostomy require a different type of ventilator.
A tracheostomy is a procedure where a doctor creates an opening in the windpipe and inserts a tube, which allows air to flow in and out. This enables a person to breathe without using their nose or mouth.
People who have undergone tracheostomies can also receive ventilator support through this opening. Instead of inserting a ventilator through the mouth, doctors insert it directly into the windpipe.
As with many medical procedures, ventilation involves some risks, particularly mechanical ventilation. The longer a person requires mechanical ventilation, the higher the risks.
Potential complications of using a ventilator include:
- atelectasis, which occurs when the lungs do not expand fully, reducing the amount of oxygen that enters the bloodstream
- aspiration, or breathing foreign substances into the airways (e.g., saliva)
- lung damage, which can happen as a result of high air pressure or high oxygen levels
- pulmonary edema, which occurs when fluid builds up inside the air sacs in the lungs
- pneumothorax, which involves air leaking from the lungs into the space just outside of them, causing pain, shortness of breath, and — in some cases — lung collapse
- infections, which can include sinus infections and, sometimes, pneumonia
- airway obstruction
- long-term vocal cord damage as a result of intubation
- blood clots or bed sores as a result of lying in one position for long periods
- muscle weakness, if a person stays on a ventilator for a long time
- delirium, which can lead to psychological trauma or post-traumatic stress disorder
Healthcare workers treating people with COVID-19 have an increased risk of coming into contact with the virus that causes it — SARS-CoV-2 — during intubation.
Doctors and nurses can take steps to reduce the likelihood of these complications. The steps include:
- closely monitoring people on ventilators for signs of complications
- adjusting the air pressure and oxygen levels to match a patient’s normal levels
- wearing personal protective equipment to protect against viruses and prevent their spread to others
- treating bacterial infections with antibiotics
- ensuring patients receive physical and pulmonary rehabilitation after they leave ICU
When a person seems ready to come off a mechanical ventilator, doctors first have to ensure the person can breathe independently. They do this via weaning, which involves gradually removing ventilator support.
During weaning, a healthcare professional slowly decreases the amount of air that a ventilator pushes into the airways.
When the support level is low enough, a doctor will try a spontaneous breathing trial, which determines whether a person can breathe with little or no support. If the trial is successful, the doctor will remove the breathing tube.
Many people who use ventilators for a short period can breathe on their own the first time doctors try weaning. In these cases, doctors may disconnect the ventilator straight away.
However, others need more gradual weaning. This is especially true if a person received mechanical ventilator support for a long time, as the muscles they would normally use for breathing may have weakened while not in regular use.
After weaning off ventilation, a person may notice that their throat feels dry and uncomfortable or that their voice is somewhat hoarse. This is normal and often improves with time.
However, if a person has any breathing difficulties after weaning, or if they experience persistent hoarseness, they should tell their doctor.
If a person requires respiratory assistance from a ventilator but their lungs are unable to cope, a doctor may recommend an extracorporeal membrane oxygenation machine. This offers respiratory support by pumping oxygen directly into the blood.
Ventilators are devices that support a person’s breathing if they are experiencing respiratory failure. There are different types of ventilator, including noninvasive and invasive, that provide varying degrees of support. Demand for ventilators has increased due to COVID-19.
It can take time to recover from being on a ventilator. Serious illness can impact mental health and physical health. People experiencing persistent symptoms after weaning off ventilator support should speak to their doctor.