Weaning Program

Mechanical ventilation is not a new invention—the first references to a form of mechanical ventilation system date back to the second century. Galen, a Roman physician, described a device that blew air into a larynx. The device was used on a dead animal at the time. A reed was used to blow air into the larynx. The first mechanical ventilation device to be used on human patients was developed in 1929. It was called the iron lung.

Medical science and technology have advanced significantly since the iron lung. Today, these medical devices are more advanced and work more effectively.

The purpose of a mechanical ventilator is to help a person breathe. These devices are used when breathing is not possible for the patient. The use of a mechanical ventilation system can save a person’s life. Several benefits need to be considered if a patient is unsure if this is an appropriate option. Still, some risks do exist as well.

Table of Contents

Why Is Mechanical Ventilation Needed?

There are several reasons why a mechanical ventilation system may be needed by a patient. Sometimes, critical illness calls for the use of these systems. There are also cases where such a device may be used on patients who are not critically ill. Patient care is a top priority at medical facilities – and when a patient faces a situation where spontaneous breathing may be difficult. It is sometimes necessary to use these systems.

A common reason why mechanical ventilation may be needed is seen among people who need to undergo a surgical procedure. During surgery, anesthetics are used to put a person to sleep. When this happens, they may have difficulty breathing while they are under anesthesia. During such a procedure, a mechanical ventilation system is used. This ensures the patient still breathes normally while the surgical procedure is done.
Some Illnesses can also make breathing difficult for a person. A few of these diseases can cause complete inhibition of the patient’s spontaneous breathing capabilities. In such cases, assisted breathing needs to be provided to the person.

A few of the conditions that may cause a patient to need mechanical ventilation include:

A premature infant may also require assisted breathing. This is common among infants born prematurely. The infant’s lungs are still developing, in which case they need support to breathe normally during the first few weeks.

Sometimes, a lung infection makes breathing difficult for a patient. In severe cases, mechanical ventilation may be offered to the individual.
People who suffered a drug overdose might also require the use of a mechanical ventilation system for a short period of time.

A certified respiratory therapist (CTR) will also suggest the use of mechanical ventilation in patients who are in a coma. This helps to ensure the patient can breathe while they are in the coma.

How Does Mechanical Ventilation Work?

There are two essential functions that a mechanical ventilation system use. Both of these are crucial to ensuring the well-being of the patient.

The two functions that a mechanical or assisted ventilator system offer include:

  • The ventilator helps to push oxygen into the patient’s lungs.
  • The ventilator also ensures excess carbon dioxide can be effectively removed from the patient’s body.

The machine helps with both inhalation and exhalation. It helps to increase oxygenated blood, which is essential for cells and bodily tissues to continue functioning.

An endotracheal tube is used with a mechanical ventilation system. This is sometimes referred to as a breathing tube. The endotracheal tube is made from a flexible material, which helps with the installation process of the machine. The part not connected to the machine will be pushed into the patient’s airways. The tube will go through the patient’s nose or mouth.

There are some cases where a more invasive procedure is needed to insert the tube into the patient’s lungs. A hole is then made in the patent’s neck. The procedure is known as a tracheostomy. The tube is then connected to the patient’s windpipe through their neck. The pressure is built up inside the ventilator machine. The pressure is used to ensure oxygenated air can be pushed into the patient’s lungs through the attached tube.

Most of the mechanical ventilators require electricity. There are a few options that can run on a battery when the device is not close to a power outlet.

What To Expect From Mechanical Ventilation ?

Mechanical ventilators are sometimes necessary to save a person’s life. The device uses a tube that is placed in the respiratory tract. It helps with the exchange of gases in the lungs, ensuring oxygen goes into the body, and carbon dioxide leaves the body. This also ensures adequate oxygen enters the circulatory system. In turn, oxygen can continue to be delivered throughout the body, even when the patient is not able to breathe on their own.

There are a few things people need to know when it comes to the use of a mechanical ventilation system. A couple of potential risks can happen when the patient is attached to the device. These may include:

Risk of Infection

There is a risk that the patient may develop an infection when they are placed on a mechanical ventilator. This is considered the primary risk of mechanical ventilation systems. Different kinds of infections can develop.
There is an increased risk of developing pneumonia in patients who are attached to an assisted breathing device. The person may also develop a sinus infection. This is especially common in people who have the tube inserted through their nose.
When an infection develops due to the use of a mechanical ventilator, the patient will need antibiotics to fight off the invading bacteria. The infection may cause several symptoms to develop. Bacterial infections may sometimes lead to the need for the patient to be transferred to the intensive care unit. This is especially important in patients with a weak immune system.

Irritation

Some patients experience irritation from the tube used with the mechanical ventilation system. The irritation can affect various parts of the body. The respiratory system, including the lungs, can develop certain symptoms due to the irritation. It is also possible for the patient to experience irritation in their throat.
The irritation is caused by the tube rubbing against tissue in the upper respiratory tract. When irritation develops, there are adverse effects that may occur. Inflammation caused by irritation in the lungs can lead to symptoms associated with the chest cavity, for example.

Injury To Lungs

It is generally rare for lung damage to occur in people who need to use mechanical ventilation, but it is still possible. There are a few factors that can cause damage to the lungs when a patient receives assisted breathing through these devices.
When too much oxygen is pushed into the patient’s lungs, they can suffer from oxygen toxicity. Pneumothorax is also a possible injury. This is when the air starts to leak in the area between the chest wall, where the intercostal muscles are located, and the lungs.

When there is too much pressure applied to the lungs, it may also lead to damage. The damage may cause other adverse effects to occur. In turn, the patient may develop lung disease. Serious lung damage can make breathing more difficult. In rare cases, severe lung disease may cause the patient to require life support, such as in the case of respiratory failure.

Vocal Cord Damage

It is also possible for mechanical ventilation to cause damage to the patient’s vocal cord. This is also a relatively rare complication, but still, one that needs to be noted. The voice box is also called the larynx. It contains the vocal cords. These vocal cords allow a person to speak. When a breathing tube is used with a mechanical ventilation machine, the tube may irritate the vocal cord. In some cases, the tube may also damage the vocal cords.

When the vocal cords are damaged, then there might be problems with the patient’s ability to speak normally following the use of the device. In some cases, the patient may notice a change in their voice. There are also scenarios where the patient is unable to speak normally following the use of an artificial ventilation system.

Weaning From Mechanical Ventilation

Mechanical ventilation is only used in patients who are unable to breathe on their own. In some cases, it is difficult to wean a patient off these devices. This is especially a concern when a mechanical ventilation system is used over a long period of time. The lungs become used to relying on the ventilation device for breathing purposes.

With this in mind, it is often not recommended to immediately remove the ventilation system from the patient. The sudden removal of the system may cause complications. The patient may not be able to breathe on their own. Instead, as the patient becomes healthier and may no longer need to use the device, there may be a weaning period.

During the weaning period, the pressure produced by the tubes may be reduced. Spontaneous breathing also needs to be tested. Pressure support or a T-tube test can be performed, according to one study. These tests can help a doctor determine if the patient’s vital signs are adequate for the removal of the ventilation system. It also shows the doctor whether or not the spontaneous breathing function in the patient’s body is working correctly.

When the results from these tests are not considered successful, then weaning from the mechanical ventilation system needs to be done gradually. The doctor needs to consider factors that may contribute to the dependence on a ventilatory system in the patient. The doctor will then address these factors to help reduce the patient’s dependency on the breathing support system.

There are a few techniques that can help during the weaning process. Synchronized intermittent mandatory ventilation is considered a highly effective strategy. The doctor can customize the settings of a synchronized intermittent mandatory ventilation system.

A specific number of inflations are delivered to the lung over a short period of time. This is followed by a pause in the delivery of the inflations. The machine will then detect if spontaneous breathing is present. In such a case, the patient’s lungs will inflate with air spontaneously – without the need for support from the device. If no inflation is detected in a specific time, the machine will continue to deliver inflations again. The procedure can be repeated to assist with the process of weaning the patient off the use of supported breathing systems.

What’re the Criteria for Weaning ?

Before a patient can be eligible for weaning, they first need to pass two specific processes:

  • Wean screen
  • Weaning performance trial

During a wean screen, doctors will analyze the weaning parameters. These screens are done every day. First, the lung disease must be stable. Then, the parameters must be within the normal range.For example, the PEEP parameter should be less than 5-8cmH20, and FiO2 less than 0.5. 

These parameters can be calculated by dividing the patient’s tidal (lung) volume.

There should be little or no in oppressors. Patients with stable hemodynamic and solid neuromuscular function often pass the wean screens. In other words, they must be able to breathe spontaneously.

To prevent delayed weaning, patients should take good care of their respiratory muscles. They will need to eat a proper diet rich in nutrients, vitamins, and minerals. They shouldn’t use any drugs that block the neuromuscular function, steroids, or anything else that might cause weakness.

The goal is to encourage patients to breathe without exhausting themselves. Doctors will address any cardiac dysfunction, anemia, or acid-base disturbance. That way, patients get to boost their carrying and oxygenation capacity.

Conclusion

There are cases where a patient’s life may depend on the use of a mechanical ventilation system. These systems help with breathing when spontaneous breathing is not functioning normally. In many cases, these patients may find themselves in a critical care unit. There are other scenarios where assisted breathing is needed too. Understanding what to expect is important. Some patients will also need to be weaned off the mechanical ventilator.

Why Cambridge?

Cambridge Medical & Rehabilitation Center is the specialized provider for Long-term Care and rehabilitation services in the United Arab Emirates. With 2 main facilities in Abu Dhabi & Al Ain, which are designed in a rehabilitation and long-term care hospital with a capacity of 90 beds each.

Cambridge provides an interdisciplinary clinical approach for Weaning from Mechanical Ventilators which is customized for adults, adolescents, and children. The best rehabilitation services are not only our goal but our ultimate objective is to customize the care plan for each patient and make sure that the patient’s family and their members are integrated into the treatment plan.

Either you joined Abu Dhabi hospital or Al Ain hospital for any kind of our rehabilitation services or even for long-term care you will feel as if you are at #Your Second Home.