Artificial lung ventilation devices (IVL)

Controllers fall off in emergency breathing recovery devices for newborns and babies of American Mercury Medical

In early October 2024, the US Food and Drug Administration (FDA) announced the recall of the Neo-Tee ventilators of the American company Mercury Medical. In these devices, a defect has been identified that can lead to the death of patients. Read more here

How the ventilator works

A ventilator lungs , as the name suggests, is a specialized medical device for mechanical involvement in a person's external breathing. With the help of a certain mechanical device, the respiratory mixture is supplied to the respiratory tract in a voluntary manner with spontaneous breathing or completely replacing the function of external breathing. The design and principle of operation of such a device is directly related to the field of application and place in the complex of medical technologies used in the hospital.

When a person needs a ventilator, the health care provider inserts an endotracheal tube (ET tube) through the patient's nose or mouth and inserts it into the respiratory throat (trachea). This tube is then connected to a ventilator. The endotracheal tube and artificial lung ventilation apparatus perform various jobs. The fan pumps a mixture of air and oxygen into the patient's lungs to deliver oxygen to the body.

A ventilator may also maintain a constant low pressure called positive end-expiratory pressure (PEEP) to keep air bags in the lungs, this is necessary to prevent air bags from collapsing. The endotracheal tube allows doctors and nurses to remove mucus from the respiratory throat by suction. If a person has a blockage of the trachea, for example, due to a tumor or a person requires a ventilator for a long period of time, then a tracheostomy procedure may be needed. During a tracheostomy, the surgeon makes a hole in the patient's neck and trachea and then inserts a breathing tube called a tracheostomy tube into the hole. The tracheostomy tube is then connected to a ventilator. The tube may remain as long as necessary, but it should not be permanent and may be removed if the patient no longer needs it. In this case, a person can talk and eat with a tracheostomy tube.

Places of use of the ventilator

• In the intensive care unit.
• In the department of anesthesiology and resuscitation.
• In the postoperative department.

Most patients on a ventilator are monitored in the intensive care unit. Any patient on a ventilator in the unit will be connected to a monitor that measures heart rate, breathing rate, blood pressure and oxygen saturation. Other studies that can be done include chest X-rays and blood sampling to measure oxygen and carbon dioxide. Members of the medical team (including doctors, nurses, respiratory therapists) will use this information to assess the patient's condition and, if necessary, make adjustments to the operation of the ventilator.

Types of ventilators

As the representative of one of the companies operating in the IVL market explained to Zdrav.expert, such equipment can be divided into the following types:

• Intensive care ventilators are the most common and popular solution for the resuscitator's workplace in intensive care and intensive care units. We often see these devices in public space (for example, in news and cinema) and it is with this class of devices that the efforts of doctors in the struggle for the lives of their patients are associated. By type of patient, such devices are usually divided into devices for children and adults, as well as for newborns and premature babies. There are also universal models for all groups of patients. In addition, specialized devices are used for complex techniques, such as high-frequency and jet IVL.

• Specialized devices for the so-called "subacute" respiratory therapy. Their use is possible not only in intensive care and resuscitation, but also in other clinical specializations that are not related to the complete replacement of respiratory independence. This includes, among other things, mask therapy with a large flow of oxygen, inhalation of various medicines, therapy of respiratory disorders in sleep and a number of other areas.

• IVL vehicles are mobile devices designed to move patients to IVL. These devices are capable of autonomously functioning both for a short time, during movements inside the hospital, and for significant periods when transporting patients outside medical institutions by special transport by land, water and air. Most often used for emergency assistance.

• Anesthesia and respiratory devices are one of the most numerous groups of ventilators. These devices are intended for the implementation of the anesthesiological aid and allow not only to replace your own breathing, but also to deliver inhaled anesthesiological substances with a respiratory mixture. The equipment is used in operating rooms and is vital to ensure painless and safe surgical treatment.

• Home ventilation devices. A special class of equipment with the simplest control, which does not require special knowledge. Patients who need constant respiratory support are needed, but it is possible to find them outside the hospital. Usually the work of such equipment is supported by special private or government agencies.

Who is prescribed mechanical ventilation

• In case of sudden arrest of blood circulation in the patient.
• In mechanical respiratory asphyxia in the patient.
• Severe damage to the chest or brain of the patient.
• Severe and superheavy intoxication in patients.
• With a strong decrease in blood pressure.
• Severe exacerbation of asthma.
• Shock conditions in the patient, including of a cardiogenic nature.
• First aid cases.
• Bronchoscopy or anesthesia.
• The need to restore respirations in newborns.

Risks when using mechanical ventilation

Artificial lung ventilation devices are a specialized technique that cannot be used without an expert doctor in this area. Our own breathing seems easy to understand. But a slightly more detailed immersion in the physiology of human external respiration allows you to see how difficult this system of our body is. Even more diverse are diseases and their manifestations, which are reflected in the respiratory system.

According to the interlocutor of Zdrav.expert, it is extremely difficult to correctly assess the state of breathing and choose the optimal solution for respiratory therapy. The effectiveness of mechanical ventilation is obvious, but, unfortunately, the safety of using mechanical ventilation still requires special attention and control. Another feature of mechanical ventilation is that despite huge progress in development, the actual mechanical inflation of the lungs is very different from natural breathing. Doctors are forced, in addition to the fight against the disease itself, which required the use of mechanical ventilation, to also concentrate their efforts on overcoming the undesirable effects associated with the non-physiology of this technology. It is very important here that the IVL devices used allow the implementation of the "protective IVL" strategy, that is, they have tools and special algorithms that minimize the undesirable effects of mechanical ventilation and protect the patient's lungs.

Problems that may develop as a result of using a ventilator include:

• Infections - Patients on ventilators are more likely to develop pneumonia, which can become a serious problem. The patient may need to stay on the ventilator for longer while pneumonia is treated with antibiotics.
• Lung collapse (pneumothorax) - sometimes a part of the lung can become weak and a hole will form through which the air leads to the collapse of the lung. If the collapse of the lung is severe enough, it can lead to death. In order to expand the lung, a tube (chest tube) must be placed in the chest to drain the flowing air. When the lung heals, the tube can be removed.
• Lung damage - The pressure of air pumped into the lungs using a ventilator can damage the lungs. Doctors try to keep this risk to a minimum by using the minimum necessary pressure that is needed. Very high levels of oxygen can also be harmful to the lungs. Doctors only give as much oxygen as is needed to make sure the body gets enough to nourish vital organs. It is sometimes difficult to reduce this risk when the lungs are damaged. However, this damage can be cured if a person can recover from a serious illness.
• Drug side effects - Sedative and painkillers can cause confusion or delirium in a person, and these side effects can continue even after stopping medication. The medical team is trying to find the right amount of drugs for a person. Different people will respond to each medication differently, and if a medication is required to prevent muscle movement, the muscles may be weak for some time after stopping the medication. Over time, this can pass. Unfortunately, in some cases, weakness persists for several weeks or months.
• The inability to stop support for mechanical ventilation due to the disease from which a person needed to connect to the device. When this happens, the health care team will discuss treatment preferences regarding continued support on the machine. Often, the health care team holds such discussions with family members or the patient himself if they are able to participate in the discussion. In situations where a person does not recover or becomes worse, a decision may be made to stop supporting the ventilator and allow death to occur.

How long is the ventilator used

Mechanical ventilation can save a life, but its use is fraught with risk. The device does not eliminate the problem that led to the fact that a person needed a ventilator, the device helps to support a person until the patient is in serious condition or until the person recovers himself.

The medical team always tries to help a person, disconnect from the ventilator as soon as possible. Disconnection refers to the process of releasing the patient from the device, some patients may be on the device for only a few hours or days, while others may require the device for a longer period. How long a patient should be on mechanical ventilation depends on many factors. The data may include the general state of the body, how well the lungs were developed before the patient got into the ventilator, as well as how many other organs were affected (for example, the brain, heart or kidneys). The condition of some people never improves so much that they can be removed from the device.

How the patient feels while on a ventilator

The ventilator itself does not cause pain, but the tube can cause discomfort, as it can cause coughing or vomiting. A person cannot speak when a ventilator tube passes between the vocal cords into the respiratory throat. The patient also cannot eat through the mouth when the tube is installed, can also feel discomfort when air is pumped into the lungs. Sometimes a person will try to exhale when the device tries to pump air, this complicates the operation of the device.

People on ventilators can be given medications (sedatives or painkillers) to make them feel more comfortable. These medications can also cause drowsiness. Sometimes, drugs that temporarily prevent muscle movement (neuromuscular blockers), this is necessary for the device to do all the work for the patient. These drugs are commonly used when a person has very severe lung damage; their reception is stopped as soon as possible and always before the ventilator is turned off.

IVL Market

• Artificial lung ventilation devices (Russian market)
• Ventilators (Global Market)