Mechanical Ventilation: Beyond the ICU

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Mechanical Ventilator

Portability

A small ventilator mounted on a wheelchair or cart can enable a ventilator-assisted individual to be more mobile, and therefore, more independent. Travel away from home for a day or more requires special arrangements, such as oxygen supplies en route, a portable power source for the ventilator, and advance arrangements for any emergency situations.

Power Sources

Most ventilators operate on regular household electrical current. A 12-volt battery should be readily available for use as an interim power source during a short-term power outage and should be checked weekly to make sure it is fully charged. The 12-volt battery also can be used to power a wheelchair-mounted ventilator. A backup electricity generator may be needed in remote areas where power outages can be prolonged; the backup generator should be operated at least once a month to make certain it is ready for any emergency.

Ventilator Circuits

Nondisposable ventilator circuits are less expensive than disposable types, but regular cleansing every 7 to 10 days is necessary: thorough washing with dishwashing detergent and water, disinfection with vinegar and water solution, followed by thorough clean water rinse and thorough drying in open air.

Humidification

All patients receiving continuous mechanical ventilation by tracheostomy should have warmed, humidified inspired air. Patients receiving noninvasive ventilation may need humidification of inspired air in dry climates or during dry winter months.

Oxygen

Medical assessment of the patient determines whether supplemental oxygen should be added to air delivered by mechanical ventilation. Tank oxygen must be available as needed and for emergencies.

Suctioning

A suction machine and supplies may be needed to regularly remove secretions from the patient's airway, especially for the patient with a tracheostomy. A member of the health-care team should teach caregivers how to suction using clean techniques to avoid infection.

Alarms

Ventilators, especially for patients with a tracheostomy, should have alarms to signal high or low air pressure changes, breathing problems of the patient, ventilator malfunction, and power failure. An alarm must be available for the patient to call for assistance.

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