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How does a ventilator work, and when is a patient recommended one?

"When a patient shows signs of recovery from infection or injury, the treating doctor may decide to begin the process of ventilator weaning," said Dr Sanjith Saseedharan

Comedian-actor Raju Srivastava, who was on life support, passed away this morning at Delhi’s All India Institute of Medical Sciences (AIIMS) after 41 days of hospitalisation. His health condition deteriorated this morning and he passed away at 10.20 am. He was admitted to the premier Delhi hospital after he suffered a heart attack while working out in a gym on August 10, 2022. He underwent angioplasty. Since then, he was on the ventilator and never gained consciousness, reported PTI.

“I got a call from the family about half an hour ago saying he is no more. It is really unfortunate news. He was fighting in the hospital for over 40 days,” Dipoo Srivastava told indianexpress.com.

How does a ventilator work?

Mechanical ventilators are automated machines that do the work of breathing for patients who are unable to use their lungs, WebMD stated. Simply put, mechanical ventilation is a form of life support. There are many reasons why a patient may need a ventilator, but low oxygen levels or severe shortness of breath from an infection such as pneumonia are the most common reasons, noted American Thoracic Society‘s Patient Education manual.

They may also be used in persons with traumatic brain injury or stroke, when the nervous system is no longer able to control breathing, according to WebMD.

Dr Sanjith Saseedharan, Consultant and Head Critical Care, SL Raheja Hospital, Mahim-A Fortis Associate told indianexpress.com that there are two types of mechanical ventilators — invasive and non-invasive. “While non-invasive involves a mask to allow the lungs to get oxygen like in the case of Covid-19, invasive ventilators involve a tube through the mouth,” said Dr Saseedharan, who has also written a book ‘MCQs in Mechanical Ventilation: A Case-based Approach (with Explanatory Answers)’.

Why are ventilators used?

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According to the American Thoracic Society, ventilators are used

*To deliver high concentrations of oxygen into the lungs.
*To help get rid of carbon dioxide.
*To decrease the amount of energy a patient uses on breathing so their body can concentrate on fighting infection or recovering.
*To breathe for a person who is not breathing because of injury to the nervous system, like the brain or spinal cord, or who has very weak muscles.
*To breathe for a patient who is unconscious because of a severe infection, build up of toxins, or drug overdose.

A ventilator mechanically helps pump oxygen into your body such that the air flows through a tube that goes in your mouth and down your windpipe. The ventilator also may breathe out for you, or you may do it on your own, noted WebMD.

As per WebMD, ventilators are set to pump air into the lungs a certain number of times per minute. “The patient’s heart rate, respiratory rate, and blood pressure are monitored constantly. Doctors and nurses use this information to assess the patient’s health and to make necessary adjustments to the ventilator”.

“When a patient shows signs of recovery from infection or injury, the treating doctor may decide to begin the process of ventilator weaning, a trial in which the patient is given a chance to breathe on his or her own but is still connected to the ventilator, in case it is needed. Once a patient is weaned from the ventilator, the breathing tube is removed,” Dr Saseedharan informed.

How long is a ventilator used?

A ventilator can be life saving, but its use has risks, stated the American Thoracic Society. “It doesn’t fix the problem that led to the person needing the ventilator in the first place; it just helps support a person until other treatments become effective, or the person gets better on their own. But the idea is to help the person recover at the earliest time possible,” Dr Saseedharan added.

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How long a patient needs to be on a ventilator depends on many factors. According to the American Thoracic Society, these can include overall strength, how well their lungs were before going on the ventilator, and how many other organs are affected (like the brain, heart and kidneys). “Some people never improve enough to be taken off the ventilator,” it notes.

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