A ventilator is one of the most important pieces of equipment doctors have at their disposal. You've probably heard a lot about ventilators recently, as they have been used extensively during the coronavirus pandemic to treat patients with severe cases of COVID-19. In essence, they are used as life support to help patients in ICU who are struggling to breathe and those who have lost the ability to breathe, ventilators have saved hundreds of thousands of lives over the years.

Understanding the basic principles of artificial ventilation, and learning what happens when someone is on a ventilator, will help to prepare you for going on a ventilator yourself. If you’re supporting a loved one who’s on ventilation or about to go on ventilation, getting an idea of what a ventilator is used for can be even more important.

What is a Ventilator?

A ventilator is a medical device designed to support or replace the breathing process when a patient is unable to breathe adequately on their own.

Modern ventilators are precisely engineered pieces of medical equipment. Used in virtually every major hospital in the world, they can help patients through severe illness, surgery and paralysis.

The primary function of a ventilator is to breathe - or support breathing – for patients who have lost the ability to respirate themselves. Ventilator support helps patients to breathe by gently forcing air into their lungs using a breathing tube inserted into the windpipe. The patient’s body then expels the air naturally. Some ventilators help patients to exhale as well as inhale like the Neopuff T-Piece Resuscitator RD900.

Patients going into surgery under general anesthesia are often put on mechanical ventilators because surgical drugs and procedures can interfere with the breathing process. Being on a ventilator will ensure that the patient is able to get enough oxygen into their system throughout the operation.

In intensive care units, ventilators are used to help patients who are struggling to breathe because of an illness or accident that causes acute respiratory distress syndrome (ARDS) or pneumothorax (collapsed lung). Taking over the breathing function for a patient can give their body time to rest and help them along the road to recovery. It can also give doctors time to try new medications, assess the condition of the patient and create effective treatment plans.

How Does a Ventilator Work?

A ventilator works by mechanically assisting or taking over the breathing process for a patient who is unable to breathe adequately on their own.

For many years, ventilators and breathing machines used negative pressure to help a patient breathe. When the body is exposed to negative pressure, it causes the thorax to expand and air to be drawn into the lungs. The most famous example of negative pressure ventilation is probably the Iron Lung, a groundbreaking machine that saved the lives of thousands of children affected by polio.

Today, most ventilators use positive pressure to help patients breathe. These ventilators push oxygen into a patient’s airway via a mask or endotracheal or tracheostomy tube. The positive pressure causes air to flow into the lungs until the ventilator breath ends. Often, oxygen is added to the air supply to ensure the patient’s levels of oxygen in the blood reach the correct level.

With a Face Mask

Using a face mask to aid oxygen intake is called non-invasive ventilation.

In this approach, a well-fitted plastic face mask covers both the nose and mouth. A tube links the mask to the ventilator, delivering air into the lungs. This method is usually preferred for less severe respiratory issues.

With a Breathing Tube

For more severe cases, endotracheal and tracheostomy tubes are inserted while the patient is under general anaesthetic. Endotracheal tubes enter the patient’s airway via the mouth while tracheostomy tubes are inserted into the throat or trachea. Tracheostomy tubes are generally used when a patient requires long periods of ventilation.

Both endotracheal and tracheostomy tubes are a type of invasive ventilation. In some cases, a non-invasive method of ventilation will be more appropriate. This delivers positive pressure to the airway via a mask. This type of ventilation increases gas exchange and reduces the amount of effort it takes for a patient to breathe.

How is Ventilation Measured?

In a clinical setting, minute ventilation (MV) is measured by multiplying the respiratory rate (RR) - the number of breaths delivered by the ventilator per minute - by the tidal volume (Vt) which refers to the amount of air delivered to the lungs with each breath. This calculation shows how regularly a patient is breathing and how much air they are able to inhale with each breath.

Doctors will monitor both the respiratory rate and tidal volume of a patient's lungs while they are on a ventilator. They will also monitor the oxygen levels and carbon dioxide saturation of the patient’s blood in order to ensure they are breathing as they should.

Types of Ventilators

There are various types of ventilators available to treat patients with different needs. Medical professionals will assess a patient, their condition, prognosis and treatment plan before deciding which type of ventilation is most suitable.

· Invasive Ventilation

Invasive ventilation is when a tube is inserted into a patient’s mouth (endotracheal) or throat (tracheostomy) to help them breathe. This tube is attached to the ventilator which uses intermittent positive pressure to gently force air into the patient's lungs.

· Non-invasive Ventilation - CPAP and BiPAP

CPAP and BiPAP are both forms of non-invasive ventilation commonly used to treat sleep apnea and other respiratory conditions.

CPAP ventilators use continuous positive pressure to help patients maintain their breathing. CPAP machines administer pressure via a mask rather than an endotracheal or tracheostomy tube. This makes them a non-invasive ventilation option. BiPAP machines offer patients pressure relief between breaths to help them exhale.

· Nasal Ventilation

Nasal ventilation is a type of non-invasive ventilation. It is often used to provide domiciliary nocturnal ventilatory support in patients with chest wall disorders, neuromuscular disease and chronic obstructive lung disease (COPD).

Like a CPAP machine, nasal ventilation works by the delivery of positive pressure to the airway. Nasal ventilation generally uses intermittent pressure to allow the patient to exhale naturally.

Ventilator FAQs

What is the Difference Between a Medical Respirator and a Ventilator?

A respirator is a masklike device, usually made of gauze, worn over the nose and mouth to prevent the inhalation of noxious substances. Health professionals wear respirator face masks to filter out virus particles so they aren’t exposed to infection when treating patients. Respirators also help to prevent the wearer from passing on any infections they may have to their patients.

Unlike ventilators, respirations don’t push air into the lungs or aid breathing. They are purely used as personal protective equipment to prevent infection and injury.

What is the Difference Between a Medical Ventilator and a CPAP Machine?

Medical ventilators work via a tube inserted into the neck or mouth of the patient, usually for critical care in ICU settings. They use short ‘breaths’ of positive pressure to gently force air into the lungs and effectively breathe for the patient.

CPAP machines, while a type of ventilator, work very differently. CPAP stands for Continuous Positive Airway Pressure. When a patient is using a CPAP machine, they will have a face mask like the Philips Pico Nasal over their nose and mouth. The machine then applies continuous pressure to their airway via the mask in order to help them breathe.

CPAP machines are used by individuals to treat conditions such as obstructive sleep apnea as prescribed by a respiratory therapist. Using a CPAP machine at night prevents patients with obstructive sleep apnea from experiencing breathing difficulties as they sleep.

How Long Can You Be on a Ventilator?

Mechanical ventilation is used as a last resort, and medical professionals will try to discontinue ventilation as soon as is safely possible. This is because there are a number of health risks associated with long term ventilation. These include:

Ventilator-associated pneumonia
Sinus infection
Blood clots
Lung injury
Damage to vocal cords

The process of taking a patient off of ventilation is called weaning. With expertise developed over years in the field, our products have been enabled to offer invaluable support and resources to medical teams. When a patient is being weaned, doctors will carry out spontaneous breathing trials. During these trials, the patient will attempt to breathe with reduced or no ventilator support. Patients undergoing breathing trials are closely monitored by a team of medical professionals. For patients who have been on a ventilator for an extended period, successful weaning may require multiple attempts.

Can a Person Recover From a Ventilator?

As an expert in the field, it's crucial to understand that while many individuals placed on a ventilator will indeed recover from their underlying illness, injury, or surgical procedure, it's important to recognize that the process of recovery can vary significantly from person to person.

Ventilators provide essential breathing support, allowing the body time to rest and heal. However, it's essential to approach each case with a realistic understanding that not all patients will recover following ventilation. Some individuals may have pre-existing conditions or severe underlying illnesses that make recovery more challenging.

It's important for healthcare providers to closely monitor patients on ventilators, adjusting treatment plans as needed and providing comprehensive care to support the healing process. This may include physical therapy, nutritional support, and ongoing medical management.

Furthermore, for patients and their families, it's essential to maintain open communication with healthcare professionals, ask questions, and participate actively in decision-making processes regarding care and treatment options.

Is it Painful Being on a Ventilator?

In most cases, the endotracheal or tracheostomy tubes used for ventilation are inserted when a patient is under general anaesthetic. This means the patient won’t experience any pain during the procedure. Once the tube is in place, it may cause a little discomfort. Patients will often be prescribed sedative and analgesic medications in order to make them more comfortable.

Patients who are on invasive ventilation can’t talk and their movement is very restricted. They also can’t eat and so receive nutrients via an IV or through nasogastric feeding. Some patients who require long term ventilation may be able to use a portable machine. This will give them more freedom of movement and greater independence.

What is the Price of a Medical Ventilator?

The cost of a medical ventilator will vary depending on its make, model and capabilities. Good quality ventilators are available for around $8,500. A range of accessories and replacement parts are available for most ventilators to help equipment last longer and work efficiently.

Where to Buy a Ventilator

Ventilators are available to purchase from recognised medical equipment supply stores. As ventilators are essential pieces of life-saving equipment, they should only ever be sourced from trusted retailers.

Explore our range of ventilators or get in touch to find out more about the products we offer. You’ll find more information on other health topics and equipment in the Medshop blog.

Author: Steven John Cumper, B.App.SC. (Osteo.), M.Ost., is a businessman with a strong foundation in biomedical science and osteopathic medicine, who founded and led Medshop to international success, culminating in its acquisition by the Bunzl Group in September 2021, where he continues to serve as Managing Director (Medshop Group).