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Mechanical Ventilation Health Article

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The iron lung was an early mechanical ventilation device, and is still in use in some hospitals. The patient's head remains outside of it, while the interior depressurizes. This allows air to push in to the lungs. Repressurizing deflates the lungs again.

A device that works on the same principle is the chest shell (something like a turtle's shell swung around to the front). The pneumobelt applies pressure to deflate, and relaxes it to allow inflation. A rocking bed is used for nighttime ventilation. Tilting the head of the bed down deflates the lungs by allowing the abdominal contents to press against the diaphragm. Reversing the angle reverses the process, allowing inflation.

Preparation

Patients with diseases in which mechanical ventilation may be required are advised to learn as much as possible about treatment options before they become necessary. In particular, it is important to learn about and make decisions about invasive vs. noninvasive ventilation before the time comes. Many patients who begin ventilation with emergency tracheostomy have a difficult time switching to noninvasive ventilation later on (though it is certainly possible).

It is often a good idea to try out different masks and other interfaces before their need arises, and to have these fitted in preparation for a planned transition to the ventilator. Patients can find support groups and other sources of information to learn more about the options and the features of each means of ventilation. Patients may have to help educate their doctors if they are not familiar with noninvasive options.

Patients with neuromuscular disease may have as much or more need for a deep cough as they do for ventilatory assistance, and many patients who undergo emergency tracheostomy do so because their airways have become clogged with mucus build up. Physical therapy cough assistance and a cough assist device are important options for full respiratory health.

Normal results

Mechanical ventilation is a life saver, and provides comfort and confidence to patients who require it. Proper ventilation restores levels of oxygen and carbon dioxide in the blood, improving sleep at night and increasing the ability to engage in activities during the day. When combined with proper respiratory hygiene, it can prolong life considerably. Patients with progressive diseases such as ALS may wish to consider end-of-life decisions before commencing mechanical ventilation, or before the ability to communicate is lost.

BOOKS

Bach, John R. Noninvasive Mechanical Ventilation. Hanley and Belfus, 2002.

Kinnear, W. J. M. Assisted Ventilation at Home: A practical Guide. Oxford: Oxford Medical Publications, 1994.

PERIODICALS

Robinson, R. "A Breath of Fresh Air." Quest Magazine 5 (October 1998) [cited July 1, 2003]. <http://www.mdausa.org/publications/Quest/q56freshair.html>.

Robinson, R. "Breathe Easy." Quest Magazine 5(October 1998) [cited July 1, 2003]. <http://www.mdausa.org/publications/Quest/q55breathe.html>.