To start invasive mechanical ventilation, a provider will:
- Give you medication to relax you (sedation) and to prevent you from moving (paralytic). You’ll most likely remain sedated, but the paralytic will wear off after you’re on the ventilator.
- Place an endotracheal (ET) tube down your throat and trachea.
- Attach the tube to a ventilator. The ventilator will help you breathe until your medical team feels it’s safe for you to breathe on your own again.
These are the general steps for starting mechanical ventilation. Some of these steps may be slightly different depending on your specific situation, especially in an emergency.
While you’re on a ventilator, providers will perform additional procedures to treat you or prevent complications. These include:
- Providing medications.
- Providing nutrition and fluids.
- Bronchoscopy.
Monitoring
Your provider will connect you to additional machines to monitor how your body is working. This includes monitoring your:
- Blood pressure.
- Heart rate.
- Respiratory rate (how many breaths you take per minute).
- Oxygen levels.
They may also look at your lungs with chest X-rays or test your oxygen and carbon dioxide levels with blood tests.
Suctioning
Suctioning is important for keeping your airways clear. A provider will insert a catheter (a thin tube) into the breathing tube to help remove mucus (secretions). It might make you cough or gag. Loved ones may find it uncomfortable to watch.
Medications
Your provider might give you aerosolized (spray) medications through your breathing tube. These medications work best when you breathe them directly into your airways or lungs. Your provider will also give you medication into your veins through an IV.
Nutrition
You can’t eat or drink normally while you’re on a ventilator and intubated. Your provider will give you liquid nutrition, usually through a tube that goes through your nose and into your stomach. They’ll give you fluids through an IV in a vein.
Mobilization
Your providers will sit you up regularly. They may get you up and walking sometimes.
Bronchoscopy
Providers use a bronchoscope to look at the airways in your lungs. They insert a small, lighted camera through the breathing tube and into your lungs. Sometimes, they’ll take samples of mucus or tissue for testing.
Providers treat you in the intensive care unit (ICU) when you need mechanical ventilation. They can closely monitor you there. All providers in the ICU are specially trained to care for people who need mechanical ventilation. Providers who might care for you include:
- Respiratory therapists.
- Physicians. This includes anesthesiologists, pulmonologists and critical care physicians.
- Nurse practitioners.
- Registered nurses.
- Nurse aides.
While you’re on a ventilator, your provider will try to keep you as awake as possible while ensuring you’re calm and comfortable. They’ll use medications as needed to keep you relaxed. It’s not uncommon for you to be awake (conscious), but you might feel sleepy, confused, or not fully aware of what’s happening.
Sometimes, depending on how sick you are, your provider may need to keep you deeply sedated (asleep) so you’re not aware and your body can recover. Your arms might be restrained to prevent you from hurting yourself by pulling on the tube.
Providers will perform tests to see if you can breathe on your own before taking you off the ventilator. The ET tube stays in place for these tests. When your condition has improved and you can breathe on your own, your provider will remove the ET tube to take you off of mechanical ventilation.
You might have a sore throat or mouth, or your voice may be hoarse after your provider removes the ET tube.
After removing the tube (called extubation) your provider may place you on other devices to help you breathe. These include noninvasive ventilation (with a mask) or oxygen masks. Sometimes, a provider may have to intubate you again and put you back on mechanical ventilation.
