You may be put on a mechanical ventilator, also known as a breathing machine, if a condition makes it very difficult for you to breathe or get enough oxygen into your blood. This condition is called respiratory failure. Mechanical ventilators are machines that act as bellows to move air in and out of your lungs. Your respiratory therapist and doctor set the ventilator to control how often it pushes air into your lungs and how much air you get.

You may be fitted with a mask to get air from the ventilator into your lungs. Or you may need a breathing tube if your breathing problem is more serious. When you’re ready to be taken off the ventilator, your healthcare team will “wean” you or decrease the ventilator support until you can start breathing on your own.

Mechanical ventilators are mainly used in hospitals and in transport systems such as ambulances and MEDEVAC air transport etc. In some cases, they can be used at home, if the illness is long term and the caregivers at home receive training and have adequate nursing and other resources in the home. Being on a ventilator may make you more susceptible to pneumonia, damage to your vocal cords, or other risks or problems.

You may need a ventilator in an emergency if a condition makes it difficult to breathe on your own (called respiratory failure). You may also need a ventilator during surgery.

Respiratory failure

Respiratory failure can be a life-threatening emergency. When you can’t breathe well, your organs cannot get enough oxygen to work. Sometimes, too much carbon dioxide, a waste gas from your body’s cells, can build up in your blood. This needs to be breathed out.

Many conditions and injuries can affect your breathing. Examples include:

• Acute respiratory distress syndrome (ARDS)
• Head injury or stroke
• Asthma
• COPD (chronic obstructive pulmonary disease) or other lung diseases
• Cardiac arrest
• Drug overdose
• Neonatal respiratory distress syndrome, which is a breathing problem that can affect newborns, especially premature babies
• Pneumonia
• sepsis, which is an infection in your bloodstream
• Spinal cord injuries, polio, amyotrophic lateral sclerosis (ALS), myasthenia gravis, and other diseases that affect the nerves and muscles involved in breathing

Surgery

You may need a ventilator if you are going to have surgery with general anesthesia (medicine that makes you sleepy and stops you from feeling pain). The medicines used for anesthesia can affect your normal breathing. A ventilator helps control your breathing.

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.

Ventilation with a face mask

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.

Ventilation 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.

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.

What to expect while on a ventilator

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.

Ongoing care

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.

What to expect when taken off a 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.

A ventilator may be necessary to help you breathe on your own. Being placed on a ventilator can raise your risk of infection such as pneumonia or other problems.

Infections

One of the most serious and common risks of being on a ventilator is developing pneumonia. The breathing tube makes it hard for you to cough. Coughing helps clear your airways of germs that can cause infections. The breathing tube that is put into your airway can allow bacteria and viruses to enter your lungs and, as a result, cause pneumonia.

Pneumonia is a major concern because people who need to be placed on ventilators are often already very sick. Pneumonia may make it harder to treat your other disease or condition. You may need special antibiotics, as the bacteria that caused your pneumonia could be resistant to standard antibiotics.

Another risk of being on a ventilator is a sinus infection. This type of infection is more common in people who have endotracheal tubes. Sinus infections are treated with antibiotics.

Other risks

Being placed on a ventilator can raise your risk for other problems.

• Atelectasis is a condition in which your lung or parts of it do not expand fully. This causes the air sacs to collapse and reduces the amount of oxygen that reaches your blood.
• Blood clots and skin breakdown can happen from staying in one position for long periods. When using a ventilator, you may need to stay in bed or use a wheelchair. This raises your risk of blood clots, serious wounds on your skin called bedsores, and infections.
• Fluid can build up in the air sacs inside your lungs, which are usually filled with air. This is called pulmonary edema.
• Lung damage can result from pushing too much air into your lungs or using too much pressure. Too much oxygen can also damage your lungs. Babies put on a ventilator, especially premature infants, may be at a higher risk of lung damage from excess oxygen therapy and lung infections in childhood and adulthood.
• Pneumothorax is a condition that develops when air leaks out of your lungs and into the space between the lungs and the chest wall, and sometimes into the muscles and tissues of your chest wall and neck. This leakage can cause pain and shortness of breath. It may cause one or both lungs to collapse. The air that enters the chest could also put pressure on your heart, resulting in a life-threatening situation that would require immediate placement of a tube in your chest to drain the air and decrease the pressure on your heart.
• Vocal cord damage from the breathing tube can damage your vocal cords. This can affect the passage of air into the lungs, especially in young children with smaller airways. Tell your doctor if you experience hoarseness or have trouble speaking or breathing after your breathing tube is removed.
• Weak diaphragm and other breathing muscles from long-term use of a ventilator can lead to some problems and delays in being taken off the machine.

If you need to be on a ventilator for the long term and your condition is stable, you may be able to use a ventilator at home. This can help avoid some of the complications of long hospital stays and improve your quality of life. You will likely use the ventilator with a trach tube or face mask.

Some people need ventilator support for life. Other people may be able to stop using the ventilator when their condition improves. For example, your baby or child may be able to go home on a ventilator while recovering from a chronic (long-term) lung or heart problem. Your healthcare team will decide if you or your child is ready to stop using a ventilator.

Preparing to use a ventilator at home

Before you go home on a ventilator, your healthcare team will teach you and your caregivers how to:

• Use and maintain your ventilator
• Change your trach tube regularly, if you are using one, to remove mucus from your airways
• Maintain the equipment needed to clear mucus and keep the airways open
• Recognize when there is a serious problem and when to call your doctor or 9-1-1 for help

After the training, your healthcare team will watch as you and your caregivers do all the tasks necessary to take care of you at home. Sometimes, they will ask your loved ones to take care of you overnight at the hospital to make sure that you are all comfortable with using the ventilator.

You may be able to hire a trained healthcare professional to come to your house while you are on a ventilator.

Equipment for home ventilation

The type of ventilator that you may need may depend on your condition. Some ventilators are portable and can be used for short trips outside of the house. In addition, you may need:

• A back-up ventilator and an extra oxygen tank, and possibly another type of oxygen therapy for emergencies
• Batteries for your ventilator, in case you lose power suddenly or for short trips outside of the house
• A suction machine to remove mucus from your airways
• A humidifier to add moisture to the air to help you breathe better
• A pulse oximeter to measure your blood oxygen levels
• A nebulizer to give you medicines for breathing treatments

Using your ventilator at home

You or caregivers will need to check all equipment regularly to make sure that everything is working well. If you think that the ventilator is not working properly, call a professional to fix it.

You will also need to keep good records of any symptoms that you may have while using the ventilator.

The following steps will help keep you or your child healthy while using a ventilator at home:

• Keep close watch over the ventilator and respond quickly to alarms.
• Wash your hands often to avoid spreading germs and avoid people who are sick.
• Avoid secondhand smoke. Cigarette smoke can cause life-threatening complications.
• Get routine vaccines recommended by your doctor and stick to your treatment plan for any other medical condition that you may have.
• Make sure your cellphone is charged at all times to call for help in an emergency.

Using a ventilator at home can be stressful for you and your loved ones. It is important that you ask for help and support whenever you need it.

It is very important that you and your caregivers follow your healthcare team’s instructions. No one should change the settings on your ventilator unless directed by your doctor. If your child is on a ventilator, a trained caregiver should be nearby and awake at all times. This may mean trading off caregiving or hiring a healthcare professional for nights.

Follow-up care

After leaving the hospital, your healthcare team will follow up regularly to make sure that your treatment is working well at home. This may include home visits by a respiratory therapist or a nurse who specializes in ventilator care. You may be able to take short trips to medical appointments if you use a portable ventilator.

Tell your electric and phone companies that someone in your household is on a ventilator. If your area loses service, these utility companies will try to restore service to your house as soon as possible. Your healthcare team can provide you with letters to send to your utility companies.

It is also helpful to keep a list of your health conditions, treatments, and medicines to give to first responders in case of an emergency.