Ventilators are mechanical devices that take over or support the breathing process. They became highly popular and in-demand during the Covid-19 pandemic to pump air into lungs. Generally, patients that stay in critical care units require ventilator support. In relation to this, ventilators continue to remain an integral part of healthcare. Respiratory therapists that operate, manage and supervise this breathing support equipment remain central to the goal of technology-backed patient management.
What is a Medical Ventilator?
Medical ventilators are used for making the lungs work. These lifesaving machines can make breathing easier for patients that cannot breathe on their own. They can only assist with breathing by pushing air in and out of the lungs manually.
Your body needs air so that it gets the oxygen it requires. Your respiratory therapist may fit you with a mask to deliver oxygen directly to your lungs. In certain severe cases, the respiratory therapist may insert a breathing tube down the throat to supply oxygen to your lungs. Typically, ventilators are used in hospital settings. Pertaining to this, they can also be used as part of in-home care.
Your respiratory therapist will work with your doctor to control the amount of oxygen that needs to be pushed into the lungs. A ventilator is known by several other names, such as a breathing machine, respirator, and mechanical ventilation.
Why Are Ventilators Important in Healthcare?
Your lungs take in oxygen when they inhale and expel carbon dioxide while exhaling. There are certain conditions that can inflame the airways and make it difficult for you to breathe. Patients may even feel their lungs drowning in fluids. A ventilator is useful in mechanically pumping oxygen to your body.
The air flows through a mask that is fixed to your face or it may go down a breathing tube to your windpipe. In severe cases, the ventilator breathes out for the patient too. These machines can be set to take a certain number of breaths per minute. Your doctor may decide the ideal program for your condition. The machine can be calibrated to kick in when a patient has not taken a certain number of breaths in a pre-defined time period.
Breathing tubes are difficult since you are not allowed to talk or eat with it. Nutrients are delivered using an IV inserted into one of the veins. With that said, ventilators are still considered a lifesaving machine. This breathing apparatus may be necessary to use in the following conditions.
Health Conditions Where a Ventilator May Help
You may suffer from breathing difficulties in the following conditions:
- Brain injury
- Cardiac arrest
- Lung infection
- Myasthenia gravis
- Acute respiratory distress syndrome (ARDS).
- Chronic obstructive pulmonary disease (COPD).
- Drug overdose
- Hypercapnic respiratory failure
- Premature lung development
- Guillain-barré syndrome
- Collapsed lung
- Coma or loss of consciousness
- Upper spinal cord injuries
Ventilator Applications in Surgery
Patients may need to be put on a ventilator if they are given general anesthesia during the surgical procedure. Anesthesia drugs may make it difficult for a patient to properly breathe during the sleep-like state. You may need to be on the ventilator temporarily while the surgery is being performed.
In certain complicated surgeries, a patient is kept on a ventilator to help them breathe following the surgical procedure. Mechanical ventilation should never be used as a breathing option for patients battling incurable conditions, such as end-stage organ failure or terminal cancer. Ventilators cannot cure patients and can only provide breathing support. It takes a qualified respiratory therapist to ensure ventilators are set up correctly.
Can Patients Use a Ventilator at Home?
Chronic obstructive pulmonary disease (COPD) is thought to be the fourth leading cause of death as per the World Health Organization (WHO). Mechanical ventilators are used for delivering oxygen to patients as and when required in this condition. Anyone that needs help with breathing can install a portable ventilator at their home.
This provides the patient with enough oxygen supply. A ventilator pushes warm and moist air through the lungs which can help patients with breathing problems. There are a number of reasons why some people prefer to invest in an at-home ventilator machine:
- Helps patients that have difficulty breathing.
- Your loved ones don’t need to remain in a hospital room.
- Personal care at home.
Home ventilators are designed on the same principles as hospital ventilators. They essentially help a patient with a breathing problem to breathe normally. All home ventilators have a mode that controls how much oxygen is supplied to the lungs. Your respiratory therapist will assess your unique condition to determine the pressure and volume of air that needs to be sent to your lungs.
Whether you require pressure support ventilation (PSV) or volume support ventilation (VSV) depends on your respiratory muscles and lung compliance. There are several features that makes it easy to install these life support machines at home. They are more compact and portable. Home ventilators also contain a longer-lasting battery as compared to hospital machines.
How Does a Ventilator Work?
There are two main types of Artificial ventilation: invasive ventilation and noninvasive ventilation. The purpose of both machines is to force air into your lungs. You may need a ventilator when you are unable to breathe adequately. Invasive ventilation forces air into the patient’s lungs through an endotracheal tube that a doctor inserts through the mouth. This is also called intubation.
Invasive ventilation may require a tracheotomy and is only reserved for patients that suffer from critical illness and are unable to breathe on their own. It may cause vocal cords, chest wall, and lung damage making it riskier as compared to noninvasive ventilation. It can also result in a sore throat. The patient doesn’t need to be intubated in a noninvasive ventilation procedure. Ventilation is required to push air through a mask placed on the patient’s mouth or nose. This is one of the least dangerous processes.
Ventilators whether connected to a mask or tube will mechanically aid with a patient’s respiratory cycle. The ventilator will recognize the beginning of the inspiration cycle in the patient and trigger the respiratory cycle. Ventilators work in the following manner:
- Inspiratory pause
- End of inspiration
Ventilation modes can be largely divided into two broad categories – controlled and assisted ventilation modes.
Controlled Ventilation Mode
Controlled or total ventilatory mode is used in patients without spontaneous respiration. This condition is also known as a respiratory arrest. Health professionals control ventilation as per the lung’s ability. Patients may be sedated throughout the ventilation period. This type of ventilation is of two types:
Volumetric or volume-controlled ventilation: the volume of air insufflated to the patient is determined during the inspiratory phase in this mode. Patients receive a fixed tidal volume (Vt) through the air sacs. Expiration is triggered by carbon dioxide levels after the Vt has been administered. Volumetric ventilation is suitable only for invasive ventilation since leaks through face masks are not compensated for.
Barometric ventilation: This mode determines the positive pressure and negative pressure of air that needs to be insufflated into the lungs. Capnography and spirometry are constantly monitored.
Assisted Ventilatory Modes
This is also known as partial ventilatory mode and is employed in patients with respiratory distress. This may be because of respiratory withdrawal. Limited spontaneous ventilation involves delivering spontaneous cycles with pressure breath. The effort to breathe on part of the patient usually triggers a spontaneous breath through synchronized intermittent mandatory ventilation (SIMV).
Who Operates a Ventilator?
According to the American Association of Respiratory Care, there are around 150,000 respiratory therapists (RT) in the US. These well-trained professionals are usually responsible for maintaining oxygen saturation levels during regular treatment and life-threatening emergencies. Respiratory therapists worked at the frontline with covid patients during the pandemic.
They also help patients with other respiratory-related illnesses that impact their breathing abilities. These professionals are trained to set up ventilators in all types of settings, whether in homes or intensive care units. They know how to deliver extra oxygen or remove carbon dioxide. They also work along with the doctor to determine when it is time to remove a patient from the ventilator.
It’s never a judicious idea to keep patients on ventilator support for an extended period of time. Moreover, there are certain patients that cannot breathe on their own. Hence, a respiratory therapist decides the right time to take off a patient from ventilator support. They possess advanced knowledge of ventilation that makes them important in any healthcare setting.
Respiratory therapists are among the few medically trained professionals that are aware of the inner workings of ventilators. They know the main parameters that need to be configured in a standard setup, such as:
- Pressure (P)
- Tidal volume (Vt)
- Inspiratory time
- Inspiratory trigger
- Respiratory rate
- I:E ratio (Inhalation/exhalation ratio)
The respiratory therapist is responsible for determining the appropriate settings on a breathing machine to keep the blood properly oxygenated. Depending on the condition, few patients may need to be kept on ventilator support for a longer period of time to allow their bodies to heal. Respiratory therapists ensure that patients have open airways. They are also responsible for responding to respiratory and cardiac arrest among other critical situations.
The primary risk of ventilators is setting the ventilation parameter. Patient-ventilator asynchronies or incorrect tidal volume adjustment may occur if an RT is not careful. This makes it important for RTs to stay on top of their game. Continuing education units can help respiratory therapists stay updated with the latest technology advancements. You can better help your patients while ensuring your license remains valid by being consistent in completing continuing education requirements.
How Much Does a Ventilator Cost?
Hospital-grade ventilators are expensive machines. Their cost can go up to $25,000 – $50,000 per machine. However, these machines are vital lifesavers since they help patients with breathing difficulties. Home ventilators are not as expensive and their cost depends on the type of machine you purchase. Most of these machines function similarly.
In accumulation to all of this, certain types of ventilators are more suitable for a specific need as compared to others. Purchasing a ventilator can cost you anywhere from $6,000 to $25,000 depending on the brand and type. You can also rent these medical machines at $500 – $1,000 per month. It can be pricey to invest in medical equipment seeing how quickly and often technology progresses.
You should always speak with your respiratory therapist or physician before purchasing a mechanical ventilator.
LTV Home Ventilators
This is the first commercially available home ventilator in a laptop-sized device with sophisticated respiratory technology. A laptop ventilator (LTV) works great for satisfying basic ventilation needs. The technology has been around for a long time and LTVs remain the most popular home ventilators. It’s trusted by the majority of respiratory therapists, doctors, and other medical professionals. There are many types of LTV home ventilators priced between $6,000 – $12,000.
Trilogy Home Ventilators
Philips Respironics-patented BiPAP and CPAP ventilation is used in Trilogy home ventilators. They provide the most comfortable and appropriate air pressure and volume for patients’ needs. The ventilator features newer technology as compared to LTVs. In relation to this, they are not right for everyone. You should discuss the benefits and limitations with your medical provider. The average Trilogy home ventilator costs around $4,000 – $10,000.
Astral Home Ventilators
The ResMed Astral series of home ventilators features cutting-edge technology like Trilogy machines. They are portable and lightweight with a long battery life. Trilogy and Astral are both well-known brands where ventilators are concerned. You should ask your medical team, respiratory therapist, and doctor for the best ventilator for your needs and situation. These are a little more expensive as compared to Trilogy machines. You may need to spend around $12,000 to $15,000 for an Astral home ventilator.
VC Home Ventilators
Multi-function VC units are the latest advances in home ventilators. They deliver both cough assist and ventilation in one machine. These ventilators are particularly beneficial for the ALS community. You can use these functions concurrently without having to switch between machines. Most insurance providers don’t cover these ventilators which can be a drawback. The cost of these ventilators depends on the manufacturer and model.
Learn More About Ventilators Through the CEUs Courses From TheCEPlace
Continuing education requirements are state and federal government-mandated in most states. At TheCEPlace, we understand that it can be difficult for a busy respiratory therapist to find the time to obtain CE credits. This is why we have designed our online courses in the most relevant and easy to understand way imaginable. There is a wide range of course options to choose from.
TheCEPlace is AARC accredited and is authorized to provide CEU courses for respiratory therapists in all 50 states and Puerto Rico. Learn more about TheCEPlace difference by calling us at 833-388-2600 or simply filling out our online form and we will revert to you shortly.