Life-Sustaining Treatments – The Big Three: CPR, Mechanical Ventilation, and Feeding Tubes: Part 2

Mechanical Ventilation | Palliative Care

Life-Sustaining Treatments (LSTs) Part 2: Mechanical Ventilation

Mechanical ventilation is a life-sustaining treatment that helps a person to breathe when they need help to breathe while recovering from illness or surgery.

Mechanical ventilation may be invasive or noninvasive. For noninvasive mechanical ventilation to work, a person needs to be able to breathe on their own. Invasive mechanical ventilation can be used to augment a person’s spontaneous breathing, and it can also be used when a person is unable to breathe on their own at all. Some of the reasons for using mechanical ventilation include a new or long-term severe lung problem, brain damage from trauma or oxygen deprivation, spinal cord injury, and severe weakness of the diaphragm or muscles of the chest.

There are two common types of noninvasive mechanical ventilation: continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP).

Mechanical Ventilation | Palliative Care

CPAP and BiPAP are also used to treat sleep apnea. Noninvasive mechanical ventilation is given through a mask over the nose and mouth that is kept in place by tight straps. The mask is connected to a machine that pushes air and oxygen into the lungs.

Invasive mechanical ventilator uses a different kind of machine called a ventilator. The ventilator is connected to a tube inserted through the nose or mouth or through a surgical opening in the neck and into the windpipe. The tube is called an endotracheal tube. The surgical opening is called a tracheostomy. The procedure of placing the tube is called intubation. An endotracheal tube is about the size of a penny in diameter.

Some people find the mask used for noninvasive mechanical ventilation to be uncomfortable. The burdens of noninvasive mechanical ventilation include dry nose and throat, nasal congestion, nosebleeds, abdominal bloating and nausea, and irritation of the eyes and skin on the face. Depending on a person’s overall condition they may not have the reserves to stay on mask ventilation for very long and may require intubation and invasive mechanical ventilation.

Mechanical Ventilation | Palliative Care

With intubation and invasive mechanical ventilation, a person is unable to talk and to eat. A person on invasive mechanical ventilation for more than a few days will require a feeding tube. Being on mechanical ventilation requires specialized health care and usually a person needs in be in a hospital or nursing home.

Intubated people are more vulnerable to infection. Having a tube in the trachea is uncomfortable and a person may try to pull it out. To prevent this, their hands may need to be restrained and they may require sedating medications.

Mechanical ventilation may or may not prolong a person’s life and may or may not be permanent. A person’s chances of recovery depend on their overall condition and how long they have been on mechanical ventilation. Some people live for years on mechanical ventilation.

If a person chooses not to have mechanical ventilation, they are still given oxygen and other medical treatment. Medications are given to help a person relax and not to feel like they are struggling to breathe. When a person chooses to stop mechanical ventilation, they might live for days or weeks, or they might die within minutes, depending how well they are able to breathe on their own.

Mechanical ventilation is one of the three major LSTs, along with artificial nutrition and CPR. With use of one LST there is often the need for lead for additional LSTs; for example a feeding tube with mechanical ventilation or mechanical ventilation for a person who survives CPR.  For some people, mechanical ventilation may restore them to the condition they were in prior to getting sick. Others will live the rest of their lives on a ventilator. Most often, the outcome is somewhere in between the two situations.

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If you would like more information on palliative care, please contact Dr. Holly Ahner by email or phone at (520) 771-2686.