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`PATIENT EDUCATION|
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`American Thoracic Society
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`Mechanical Ventilation
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`ventilator is a machine that helps people breathe when they are
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`not able to breathe enough on their own.The mechanical ventilator
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` Mechanical ventilation is a life support treatment. A mechanical
`hospital, a rehabilitation facility, or cared for at home.
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`is also called a ventilator, respirator, or breathing machine. Most
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`patients who need support from a ventilator because of a severe
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`illness are cared for in a hospital’s intensive care unit (ICU). People
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`who need a ventilatorfora longer time may be in a regular unit ofa
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`therapists) will use this information to assess the patient’s status
`and make adjustments to the ventilator if necessary.
`How long is a ventilator used?
`A ventilator can be life saving, but its use also has risks. It also
`doesn't fix the problem that led to the person needing the
`ventilator in the first place; itjust helps support a person until
`other treatments become effective, or the person gets better
`on their own. The health care team always tries to help a person
`get off the ventilator at the earliest possible time. "Weaning"
`refers to the process of getting the patient off the ventilator.
`Some patients may be on a ventilator for only a few hours or
`days, while others may require the ventilator for longer. How
`long you may need to be on a ventilator depends on many
`factors.These can include your overall strength, how well your
`lungs were before going on the ventilator, and how many other
`organs are affected (like your brain, heart and kidneys). Some
`people never improve enough to be taken off the ventilator
`completely or at all.
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`The ventilator is connected to the person through a tube
`(endotmchem' or ETtube) that is placed into the mouth or nose
`and down into the windpipe. When the health care provider
`places the ET tube into the person's windpipe, it is called an
`intubation. Some people go through surgery to have a hole
`place in their neck a nd a tube (tracheostomy or “tmch” tube) is
`connected through that hole. The trach tube is able to stay in
`as long as needed. At times a person can talk with a trach tube
`How does a patient feel while on a ventilator?
`in place by using a special adapter called a speaking valve. {For
`more information on having a tracheostomy see ATS patient
`The ventilator itself does not cause pain. Some people don't
`information series at www.thoracic.orglpatients).
`like the feeling of having the tube in their mouth or nose.
`They cannot talk because the tube passes between the vocal
`The ventilator blows gas (air plus oxygen as needed) into a
`cords into the windpipe.They also cannot eat by mouth when
`person's lungs. It can help a person by doing all ofthe breathing
`this tube is in place. A person may feel uncomfortable as air is
`orjust assisting the person’s breathing. The ventilator can
`deliver higher levels of oxygen than delivered by a mask or
`pushed into their lungs. Sometimes a person will try to breathe
`other devices. The ventilator can also provide what is called
`out when the ventilator is trying to push air in. This is working
`positive end expiratory pressure (PEEP). This helps to hold the
`(or fighting) against the ventilator and makes it harder for the
`lungs open so that the air sacs do not collap5e. The tube in the
`ventilator to help.
`windpipe also ma kes it easier to remove mucus if someone has
`People on ventilators may be given medicines (sedatives
`a weak cough.
`or pain controllers) to make them feel more comfortable.
`These medicines may also make them sleepy. Sometimes,
`How are patients on ventilators monitored?
`medications that temporarily prevent muscle movement
`Anyone on a ventilator in an ICU setting will be hooked upto
`(neuromuscular blocking agents) are used to allow a person
`a monitor that measures heart rate, respiratory rate, blood
`to breathe with the ventilator. These agents are typically used
`pressure, and oxygen saturation (“o2 sats"). Other tests that
`when a person has very severe lung injury; they are stopped
`may be done include chest-x—rays and blood drawn to measure
`as soon as possible and always before ventilator support is
`oxygen and carbon dioxide ("blood gases"). Members of
`removed.
`the health care team (including doctors, nurses, respiratory
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`ATS Patient Education Series (D 2017 American Thoracic Society
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`www.thoracic.org
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`UNITED THERAPEUTICS, EX. 2008
`WATSON LABORATORIES V. UNITED THERAPEUTICS, |PR2017-01622
`Page 1 of2
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`Why are ventilators used?
`I To get oxygen into the lungs and body
`I To help the body get rid of carbon dioxide through the lungs
`I To ease the work of breathing—Some people can breath on
`their own, but it is very hard. They feel short of breath and
`uncomfortable.
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`I To breathe fora person who is not breathing because of injury
`to the nervous system, like the brain or spinal cord, or who has
`very weak muscles.
`How does a ventilator work?
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`PATI E NT E D UCATI 0 N | 5".'.-'-" '
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`American Thoracic Society
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`Some people have very specific thoughts about if and when they
`should be placed on a ventilator. Although the healthcare team
`helps people and theirfamilies make tough decisions about the
`end of life, it is the person him or herself who has the final say. If
`a person cannot talk or communicate decisions, the healthcare
`team will talk with his or her legally authorized representative
`{usually a parent, wife or husband, adult child, or next of kin).
`It is important that you talk with your family members and
`your heaith care provider about using a ventilator and what you
`would like to happen in different situations. The more clearly you
`explain your values and choices to friends, loved ones and the
`heatlhcare team, the easier it makes it for them to follow your
`wishes if and when you are unable to make decisions yourself.
`Advance directives are ways to also put your wishes in writing
`to share with others. In the hospital, nurses, doctors and social
`workers can provide information about an advance directive
`form . You can also obtain information on advance directives
`from your primary care provider, state Attorney General's office,
`public health department, or organizations such as Aging With
`Dignity (wwwagingwithdignity.org) and PREPARE forYour Care
`{https:,-'.-'www.prepareforyourcareorgfml.
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`Source: Manthous, C., Tobin, MJ. A Primer on Critical Care for
`Patients and Their Families. 1st issued in 200:1; 201y—2013 Update to
`be posted on www.thoracic.orgipatients
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`Authors: Martin Tobin, MD; Constantine Manthous.
`Reviewers: Marianna Sockrider MD, DrPH
`Hrishikesh S Kulkami, MD, Ann C Long, MD MS
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`8( What to do...
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`I/ Ask the healthcare team to explain why a ventilator is
`needed
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`I/ Share any concerns you have about use ofthe ventilator
`I/ Work with healthcare team to help your loved one be as
`comfortable as possible while on a ventilator.
`Healthcare Provider's Contact Number:
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`Additional Resources:
`AmericanThoracic Society
`www.moracicnrgfpatients
`National Heart Lung 8: Blood Institute
`httpsdlwww.nhlbi.nih.govfl1ealthihealth-topicsrtopicsrvent
`Family Ca regiver Alliance National Center on Caregiving
`http:l!www.caregiver.org
`Aging With Dignity
`www.agingwithdignity.org
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`This information is a public service of the American Thoracic Society.
`The content is for educational purposes only. It should not be used as a
`substitute for the medical advice of one’s healthcare provider.
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`www.thoracic.org
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`What are risks of mechanical ventilation?
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`Problems that can develop from using a ventilator include:
`I Infections—The ET or trach tube allows germs (bacteria) to
`get into the lungs more easily. This can cause an infection like
`pneumonia. Pneumonia can be a serious problem and may
`mean a person has to stay on the machine longer. Pneumonia
`can often be treated with antibiotics. Also see ATS Fact Sheet
`on Pneumonia at www.thoracic.org;lpatients.
`I Collapsed lung (pneumothorax)—Sometimes, a part of the
`lung that is weak can become too full of air and start to leak.
`The leak lets air get into the space between the lung and the
`chest wall. Air in this space takes up room so the lung starts to
`collapse. Ifthis air leak happens, the air needsto be removed
`from this space. A different kind of tube (chest tube) can be
`placed into the chest between the ribs to drain out the extra
`air.The tube allows the lung to re—expand and seal the leak.
`The chest tube usually has to stay in for some time to make
`sure the leak has stopped. Rarely, a sudden collapse ofthe
`lung can cause death.
`I Lung damage—The pressure of putting air into the lungs with
`a ventilator can damage the lungs. Doctors try to keep this
`risk at a minimum by using the lowest amount of pressure
`that is needed.Very high levels ofoxygen may be harmful
`to the lungs as well. Doctors only give as much oxygen as it
`takes to make sure the body is getting enough to supply vital
`organs. Sometimes it is hard to reduce this risk when the lungs
`are damaged. However, this damage may heal if a person is
`able to recover from the serious illness.
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`I Side effects of medications—Sedatives and pain medications
`can cause a person to seem confused or delirious, and these
`side effects may continue to affect a person even after the
`medications are stopped.The healthcare team tries to adjust
`the right amount of medication for a person. Different people
`will react to each medicine differently. If an agent to prevent
`muscle movement is needed, the muscles may be weak for a
`period oftime after the medication is stopped.This may get
`better over time. U nfortunately, in some cases, the weakness
`remains for weeks to months.
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`I Inability to discontinue ventilator support—Sometimes,
`the condition which led a person to need a ventilator does
`not improve despite treatment. when this happens, the
`healthcare team will discuss your treatment preferences
`regarding continued ventilator support with you, if you are
`able. Often the healthcare team will have these discussions
`with your family, as you may be unable to participate due to
`the severe nature of your illness. In situations where a person is
`not recovering or is getting worse, a decision may be made to
`discontinue ventilator support and allow death to occur.
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`How can I make my wishes about using a
`ventilator known?
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`Mechanical ventilation is a “life-sustaining treatment". It is a
`treatment that can prolong life. It may be needed for only a
`short time. However, some people cannot be weaned off the
`ventilator and do not want to stay on the machine. Other people
`who know they have a very severe lung or health problem may
`not even want to use a ventilator at all. That is because the
`ventilator cannot fix their underlying condition.
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`UNITED THERAPEUTICS, EX. 2008
`WATSON LABORATORIES V. UNITED THERAPEUTICS, lPR2017-01622
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