Myths and facts about ICU ventilator: small boat in sea storm


 

 Some one who is drowning, a small boat can  save his life, till sea storm settles or the victim reaches a safe land. The boat will not settle the sea storm, but enough to save a person from catastrophe. In reality, ventilator is the invention, which should be worshiped. But contrarily, due to wrong projections and misguided perceptions, it has been hated despite saving lives.

     Although doctors and ventilators are in a similar situation, projected in a wrong way,  hated in spite of doing good work and saving lives. They are hated and despised, despite the only ones of help in life and death situations. Following are few myths and fact about ventilator.

  1. Myth : Once on ventilator, patients do not survive: common myth is that  once the patient is placed on ventilator, he will not survive.  Human body,  when  gets severely  diseased or  under stress, heart and lungs need to be supported for saving the life, till ailment    So, when the battle for saving live is ongoing, almost all the patients will have to be placed on the ventilator. It is a last ditch attempt made to save the patient’s life. However when the patients do not survive people feel that it’s the ventilator which has caused death, rather than a rational thought about severe disease as a cause.

             In reality, it is the severity of disease and possibility of death, when ventilator is required. It is necessary to support life.

  1. Myth : Ventilator is a modality for mere prolongation of life: every disease has a spectrum. Every disease can progress  from a reversible  to irreversible state. As an effort is ongoing while waiting to reverse the process, the patient will need  ventilator to sustain life. Unless the disease reaches a stage of  irreversibility,  ventilator is indispensible  for an  absolute need to maintain life. Since in serious condition, it is an uncertain prognosis.  In retrospect, combined with application of an average wisdom, the time of uncertainty and institution of ventilator   can be  interpreted  as a mistake.  As the whole exercise is labeled as futile and expensive by relatives.   it’s a grey area and the  negative thoughts are fuelled because of retrospective wisdom in hindsight.  The real prognosis can not be predicted in real time.

In reality, Ventilator is a machine which just  supports respiration and not  responsible for  heart beating. Therefore it   buys time for healing and treatment of primary disease.

  1. Myth : Ventilator will cause death:

one can understand this simple logic on the basis that patients are placed on dialysis when kidneys fail. Patients are placed in cast when bones are fractured for a fixed predefined period of time. Similarly patient is placed on ventilator when lungs fail. Ventilator is used till the time  lungs recover and become fully functional.

                        In reality; Risk is because of disease, which needs ventilator and not vice versa. Ventilator is a friendly machine which helps people who have failed lungs.

  1. Myth : Doctors and hospitals keep dead patients on ventilator for financial gains

Fact:  placing patient on ventilator is a very critical decision, taken in best interest of patient to buy time, to so as to treat the disease.  A patient needing on ventilator is actually so sick, that not  instituting ventilator will risk the patient’s life. Knowing all these facts, doctors take a decision to keep the patients on ventilator.

         As once the patient is on ventilator,  it is a stress for the doctor to take the patient off the ventilator. As such ventilator is a SANCTUM SANCTORUM life saving machine,  to be used only in life and death situations.

 

  1. Myth : Its miracle if the patient placed on ventilator survives.

Given the fact that placing the patient on ventilator on scientific facts. There are clear indications  for putting the patient on ventilator.   A much larger patients put on ventilator are actually saved and go home.

Fact:  Everyday thousands of patients are placed on ventilator and sent home to lead a normal life: Any patient who is given general anesthesia is placed on ventilator in the operation theater and then taken off the ventilator at the end of the surgery. In these cases patients are placed on ventilator so as patient can be put to deep sleep (called anesthesia) during which surgery on desired part can be carried out. Soon after the surgery patient are taken off the ventilator and soon thereafter discharged for home after few days of healing.

 

  1. Myth :Doctors place patients on ventilator at their own will:

Fact:   there are scientific parameters which decide when the patient should be placed on the ventilator and when the patient should be taken off the ventilator. So the decision to place the patient is scientific and based on objective parameters.

  Contrary to this popular myth, it is a compulsion for the doctor to put patient on ventilator to prevent death in serious situations.  Doctors are usually thinking several steps ahead of lay person about medical science.

  1. Myth :All patients placed on ventilator are unconscious:

 

Fact: this is not necessary. Usually patients are sedated  for their comfort.  they can be made to walk, write and even perform small tasks when on ventilator, depending upon their lung condition.

  Patients are also put on ventilator in case of airway failure when unable to protect their airway for various reasons. Another reason why patients are placed on ventilator is inability of the patients to protect his or her airway. Conscious and alert patients can swallow normally formed mouth secretions.  When patients consciousness level is dulled the ability of the patient to protect his airway is lost or compromised. This causes secretions from mouth to enter into the lungs trough the airway i.e. trachea causing infections in the lungs. The only way to prevent this and protect the patient’s lungs is to place a tube in his airway and then place them on the ventilator.

 

  1. Myth: Patients can be kept alive by placing on the ventilator:

General masses  have a feeling that patient can be kept alive by keeping them on the ventilator. Even  a dead person can be kept alive by placing on the ventilator, which is not true.

In reality:  It is machine used only for breathing and not heart and brain.

  1. Myth : Ventilating the dead patients:

    this is a common allegation on medical profession.  This is no truth in this projected and perceived hearsay.

       Facts: Assumptions are based on thoughts of lay persons. Patients on ventilator, may look like dead, because of the disease, sedation and paralyzed by drugs. But their heart and brain are working, so they can not be declared dead.

    If there is some incident, it  needs to be proved by medical personnel. In reality, it can  be a very rare and remote  exception. These untrue projection are creating lots of mistrust about life saving machine.

The problem is about correct projection and  majority of people without  knowledge of medical science  do not  even  know the large  number of lives  been saved by the ventilators.

In nutshell: serious conditions  and life threatening situations need higher technical interventions, to save a life. If correct projections are made, ventilators are life saving machines.

About ventilator

History of ventilator

History of mechanical ventilator 


                

The history of mechanical ventilation begins with various versions of what was eventually called the iron lung, a form of noninvasive negative pressure ventilator widely used during the polio epidemics of the 20th century after the introduction of the “Drinker respirator” in 1928, improvements introduced by John Haven Emerson in 1931,  and the Both respirator in 1937. Other forms of noninvasive ventilators, also used widely for polio patients, include Biphasic Cuirass Ventilation, the rocking bed, and rather primitive positive pressure machines.

In 1949, John Haven Emerson developed a mechanical assister for anesthesia with the cooperation of the anesthesia department at Harvard University. Mechanical ventilators began to be used increasingly in anesthesia and intensive care during the 1950s. Their development was stimulated both by the need to treat polio patients and the increasing use of muscle relaxants during anesthesia. Relaxant drugs paralyze the patient and improve operating conditions for the surgeon but also paralyze the respiratory muscles.

In the United Kingdom, the East Radcliffe and Beaver models were early examples, the latter using an automotive wiper motor to drive the bellows used to inflate the lungs. Electric motors were, however, a problem in the operating theaters of that time, as their use caused an explosion hazard in the presence of flammable anesthetics such as ether and  cyclopropane .

In 1952, Roger Manley of the Westminster Hospital, London, developed a ventilator which was entirely gas driven, and became the most popular model used in Europe. It was an elegant design, and became a great favorite with European anesthetists for four decades, prior to the introduction of models controlled by electronics. It was independent of electrical power, and caused no explosion hazard. The original Mark I unit was developed to become the Manley Mark II in collaboration with the Blease company, who manufactured many thousands of these units. Its principle of operation was very simple, an incoming gas flow was used to lift a weighted bellows unit, which fell intermittently under gravity, forcing breathing gases into the patient’s lungs. The inflation pressure could be varied by sliding the movable weight on top of the bellows. The volume of gas delivered was adjustable using a curved slider, which restricted bellows excursion. Residual pressure after the completion of expiration was also configurable, using a small weighted arm visible to the lower right of the front panel. This was a robust unit and its availability encouraged the introduction of positive pressure ventilation techniques into mainstream European anesthetic practice.

The 1955 release of Forrest Bird’s “Bird Universal Medical Respirator” in the United States changed the way mechanical ventilation was performed, with the small green box becoming a familiar piece of medical equipment.  The unit was sold as the Bird Mark 7 Respirator and informally called the “Bird”. It was a pneumatic device and therefore required no electrical power source to operate.

Intensive care environments around the world revolutionized in 1971 by the introduction of the first  Servo 900 ventilator Elema – Schonander . It was a small, silent and effective electronic ventilator, with the famous SERVO feedback system controlling what had been set and regulating delivery. For the first time, the machine could deliver the set volume in volume control ventilation.

Ventilators used under increased pressure (hyperbaric) require special precautions and few ventilators can operate under these conditions. In 1979, Sechrist Industries introduced their Model 500A ventilator which was specifically designed for use with hyperbaric chambers.

In 1991 the SERVO 300 ventilator series was introduced. The platform of the SERVO 300 series enabled treatment of all patient categories, from adult to neonate, with one single ventilator. The SERVO 300 series provided a completely new and unique gas delivery system, with rapid flow-triggering response.

In 1999 the LTV (Laptop Ventilator) Series was introduced into the market. The new ventilator was significantly smaller than the ventilators of that time weighing ~14 lbs and around the size of a laptop computer. This new design kept the same functionality of the in hospital ventilators, while now opening up a world of opportunity of mobility for the patients.

A modular concept, meaning that the hospital has one ventilator model throughout the ICU department instead of a fleet with different models and brands for the different user needs, was introduced with SERVO-i in 2001. With this modular concept the ICU departments could choose the modes and options, software and hardware needed for a particular patient category.

mechanical ventilator

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