Overview: ICU Ventilator

An ICU ventilator is used to provide ventilation to severely ill patients. Patients suffering from severe illness or lung infection often need ventilator support to breathe. The covid-19 pandemic has increased the demand for ventilators in a very short time. Before the pandemic, ventilators didn’t have a significant need. Patients having covid-19 need ventilator support when their oxygen saturation goes below than normal. In addition, certain other conditions demand ventilation.

Ventilation is the process of providing air enriched with oxygen to the patient’s windpipe. There are two methods by which ventilators work: intubation and tracheostomy. Intubation is placing a tube (endotracheal tube) through the mouth into the windpipe. 

Ventilators work in different modes and come in various types according to the patient’s requirements. 

Modes of ventilator 

A ventilator mode can be defined as a set of ventilator operations with one or more predetermined breathe types. Although, it’s impossible to know all ventilator modes because the old modes change with time and new ones keep developing. 

There are three basic modes of ventilators:- 

• Conventional ventilation mode
• Adaptive ventilation mode
• Biphasic ventilation mode 

Conventional ventilation mode:- it is the widely used ventilation mode because the ventilator works according to the operator’s setting. Conventional modes are the foundation of ventilation modes. Not even a single operation is set automatically in this mode. 

There are five conventional ventilation modes:- 

• Volume assist/ control
• Pressure assist/control
• Pressure support ventilation
• Volume synchronised intermittent mandatory ventilation
• Pressure SIMV

Adaptive ventilation mode:-It’s a standard mode in which one or more operations are automatically controlled. While, in more advanced adaptive ventilator mode, the ventilator can control several settings at once. 

During the process of mechanical ventilation, a patient’s conditions can change including:- 

• The ventilatory demand
• Breathing activities
• The respiratory resistance and compliance
• The functioning of a ventilator system 

The ventilator works as a system in which settings have to be changed according to the patient’s needs. The operator has to change its settings to make it function appropriately. Also, if the operator has recently set the ventilator system, it’s quite possible that the requirements change for the patient with time and the operator has to readjust it. 

Furthermore, highly specialised knowledge is needed for the readjustment of the ventilator. This is all for the conventional methods that need the operator’s assistance frequently. However, adaptive ventilation mode has improved and has made ventilation automatic. 

Biphasic ventilation modes 

It’s the special mode in ventilators where a patient can breathe spontaneously at different levels. Due to its continuous positive airway pressure. 

And the baseline pressure oscillates periodically between two positive pressures according to the operator’s setting.  

How are patients monitored on ventilators? 

Patients on ventilators are monitored in an ICU. The tube is connected to a ventilator and a monitor that measures respiratory rate, heart rate, blood pressure and oxygen saturation levels. Some other tests are also done with being put on a ventilator such as a chest X-ray, blood test to measure oxygen and carbon dioxide. The healthcare team checks the patient’s current status continuously and makes adjustments to the ventilator according to that. 

How is the ventilation done? 

Ventilation is done by mainly two procedures: intubation and tracheostomy. Let’s know about it in detail. 

Intubation 

In this process, a tube (endotracheal tube) is put down the patient’s throat into the windpipe to create an easy passage for air. 

There can be many purposes for intubation such as:-

• Removing blockage in air passage
• Clearing the airway to provide oxygen, medicine, and anaesthesia. 
• Helping the people with collapsed lungs, lung failure and trauma. 

The intubation procedure depends on the purposes for which it is used, like whether it is needed in the operation room or an emergency. While performing the intubation, the doctor sedates the person with an anaesthetic, and an instrument called a laryngoscope is inserted into the person’s mouth to support the insertion of the endotracheal tube. The laryngoscope is used to detect and protect sensitive tissues like vocal cords, or else a tiny camera can also be used. Usually, in operating rooms, intubation is used to help people with anaesthesia. 

The doctor observes a patient’s breathing after inserting the tube to ensure the tube is correctly placed inside. And if the patient feels any discomfort, the doctor removes the tube from their throat. Usually, intubation is done in emergency conditions to save a patient’s life. The process is very beneficial while there is a need for airway assistance and management, and has proved life-saving during covid-19. 

On the other hand, emergency intubation can be risky and requires additional care like image scans to correctly place the tube, and needs assistance from experienced medical professionals. 

Tracheostomy 

A tracheostomy is also a procedure to support mechanical breathing with a tracheostomy tube. The process can be temporary or permanent depending upon the situation. The process is initiated by creating an incision in the neck to make the space to fit the tube into a patient’s windpipe. The flexible endotracheal tube is inserted through the cut in the neck, which allows air to enter the lungs.

A tracheostomy is done in many conditions, including restricted air pathways. It could be an emergency condition when your airways get blocked, or during a disease that makes breathing impossible. 

Usually, a tracheostomy requires local anaesthesia, which means a patient will be aware throughout the procedure. Once the given anaesthesia starts working and the area around your neck gets numb, the doctor starts the process. A tracheostomy involves an incision in the neck that will go through the outer walls of your trachea known as the windpipe, and the hole is wide opened to completely fit the tube inside. Also, the tube is connected to a ventilator to make you breathe continuously.The tube will be secured in place with a band that goes around your neck. This helps keep the tube in place while the skin around it heals. The medical staff help the patients in taking care of the wound. 

Are ventilators portable? 

Yes, portable ventilators are available in the market. They are used in hospitals for easy moving of ventilators from one place to another so that they can fit any environment according to the patient’s need. Portable ventilators require low maintenance and are lightweight. Patients who do not need complex care ventilator support use portable ventilators at home. These ventilators deliver oxygen-enriched air in the breathing circuit from an oxygen source and consist of a monitor, a control system and alarms. Portable ventilators are highly convenient for people who need long-term ventilatory support. 

What ventilators AgVa Healthcare provide? 

AgVa Healthcare provides three effective and economical ventilators namely ICU one ventilator, AgVa pro ventilator and AgVa pro+ ventilator. Further details can be seen here