What is Respiratory Support Therapy?

Respiratory support therapy is necessary when it comes to the safe maintenance of breathing during surgery or the treatment of a serious lung disease or other condition that affects normal breathing. In cases where respiratory support is needed, breathing can be supported with a device called a ventilator.

What is a ventilator?

A ventilator is a respiratory support device. A ventilator may be used during surgery or when treating a serious lung disease or other condition that affects normal breathing. The ventilator is mostly used in hospitals but sometimes in the home environment.
Ventilator; It is also called a mechanical ventilator, respirator, respirator or artificial respiration device.

How Long Does Ventilator Respiratory Support Continue?

When the patient is able to breathe adequately after the surgery is over

But some people may need ventilators for very long periods of time or perhaps for their entire remaining life. In such cases, ventilators can be used outside the hospital - in nursing homes or even at home. ?

• Infections

One of the most serious and common risks of being on a ventilator is pneumonia (lung infection). The tube placed in the trachea can facilitate the entry of bacteria into the lungs. As a result, Ventilator-Associated Pneumonia (VAP) may develop. A breathing tube can make coughing difficult, and some medications can suppress coughing. Coughing is a reflex that clears the airways of substances that are irritating to the lungs and cause infection. Pneumonia can also complicate the treatment of other diseases of the patient. VAP is treated with antibiotics. In patients who develop VAP, samples taken from the secretions in the airways are subjected to microbiological examination with aspiration or sometimes with a bronchoscope. If bacteria that do not respond to standard antibiotics are identified, which antibiotics Antibiogram determines that they are resistant and sensitive to antibiotics, and antibiotic treatments are arranged with the recommendations of infectious diseases specialists.
Another risk in ventilator-dependent patients is sinus infections. Sinus infections, especially seen in nasally intubated patients, can also be seen in patients with oral tube placement. For this reason, a tracheostomy tube is placed in the very early period when the ventilator therapy is predicted to take a long time, and when the duration is prolonged if it is unpredictable. Sinus infections are also treated with antibiotics.

The patient on the ventilator is also at risk for other problems:

• Pneumothorax: It is the leakage of air from the lungs into the space between the lung and the chest wall. It can cause pain and shortness of breath. It can cause one or sometimes both lungs to contract. It can put pressure on the heart.

• Lung damage: Injecting air into the lungs with too high pressure can cause damage to the lungs.

• Oxygen toxicity : High concentrations of oxygen can also cause damage to the lungs.

The patient on the ventilator is also at risk of blood clots and serious skin infections. These problems are more common in certain diseases (diabetes, vascular diseases). These problems are more common in patients who are bedridden, stay in a certain position in bed or in a wheelchair for a long time.

What Does a Respiratory Support Device (Ventilator) Do?

Respiratory support device/ventilators ;

• They provide respiration in people who have lost the ability to breathe on their own.
• They carry oxygen to the lungs.
• They remove carbon dioxide from the body (carbon dioxide is a waste gas that can also be toxic).
• They allow patients to breathe more easily.

Who Needs a Respiratory Support Device (Ventilator)?

Ventilators are most commonly used during general surgery during surgery. It is used in patients under anesthesia. Sleeping drugs used to create anesthesia, strong painkillers and drugs that provide muscle relaxation affect the respiratory system. Therefore, a ventilator is used to support respiration.

Also, when lung functions are impaired as a result of a disease or condition, it is necessary to support respiration with a ventilator

Why Respiratory Support (Mechanical Ventilation) is Necessary in Surgery?

General anesthesia provides temporary sleep in surgeries, and drugs used for sleeping can also disrupt normal breathing. For this reason, it is necessary to apply respiratory support therapy with a ventilator in surgeries.
A patient receiving general anesthesia during surgery is likely to be connected to a ventilator. Medications used to initiate anesthesia can stop normal breathing. The ventilator helps maintain breathing (artificial respiration) during surgery. After surgery, the patient is often unaware that he or she is connected to a ventilator.

The only symptom he may be aware of is a mild sore throat, which may be caused by a tube (endotracheal tube) connecting the ventilator to the airway, albeit for a short time. When anesthesia is terminated and the patient begins to breathe adequately, the ventilator is disconnected and the tube placed in the throat (in the windpipe) is also removed. All these procedures take place just after the operation is over and just before the patient wakes up completely. The proportion of patients who remain connected to a ventilator after surgery constitute a very small proportion of patients who have undergone surgery.

Respiratory Support Therapy when Lung Functions Deteriorate

A ventilator may be required when a disease, condition or other factor impairs breathing . Even if the person can breathe himself, it may take a great deal of effort and energy to breathe. He may feel short of breath and severe discomfort. In such a situation, the ventilator can facilitate breathing and reduce the work of breathing. Patients who cannot breathe themselves are also connected to a ventilator.
There are many diseases, conditions and factors that affect lung function:

• Pneumonia and other infections
• COPD (Chronic Obstructive Pulmonary Disease) or other lung diseases
• Diseases, injuries, conditions affecting the nerves and muscles involved in the respiratory function (Upper Spinal Cord Injuries, Polio-Polio, Myasthenia Gravis, Guillain - Barre, Amyotrophic Lateral Sclerosis-ALS)
• Head trauma, cerebral hemorrhage, stroke
• Taking high doses of drugs

Ventilator ki It helps her to breathe until her work gets better. If there is not enough recovery to breathe on his own, the need for a ventilator may continue for the rest of his life.

What to Expect from Respiratory Support Therapy (Mechanical Ventilator)

Ventilators do not cause pain. The tube in the airway can cause some discomfort. They can also interfere with the ability to eat and talk. The tube inserted into the airway may be an endotracheal tube inserted through the mouth (or sometimes through the nose) or a tracheostomy tube inserted directly into the trachea through the anterior neck wall. Eating and talking may be possible in the presence of a tracheostomy tube.
The ventilator greatly restricts daily activities and movements. Even if it is possible to sit in a bed or on a sofa, there is no possibility to move much and get away from the environment.
A portable device can be used when a ventilator is needed for a long time. Such a device may enable the person to move freely and go out, but it requires the ventilator to be carried with the person at all times. By adjusting the ventilator according to the patient's situation, the mechanism that allows the device to send air to the lungs can be triggered and activated. In cases where this mechanism cannot be activated or triggered by the patient within the preset time, the ventilator automatically ventilates the lungs.

Disconnecting the Patient from the Ventilator (Termination of Ventilator Therapy)

Individuals, their own breathing When they reach a sufficient level, they are disconnected from the ventilator. This can usually happen after the problem that requires the ventilator has cleared up enough. The process begins with short-term trials. In the process of starting the trials, the patient is allowed to breathe for a while. These periods are gradually increased and it is tried to adapt to the new situation. While many patients are successfully weaned off the ventilator on this first attempt, it may take longer for some patients. When the patient himself manages to breathe adequately, the ventilator is turned off.
After the patient leaves the ventilator, the tube through which breathing is provided is removed. During this time, the patient may cough. After the tube is removed from the trachea, the voice is hoarse for a short time.
Repeated efforts to wean from the ventilator may not occur for a long time, in which case the patient has to live with the ventilator for a long time.

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