Tracheotomy (tracheostomy, trach)—Surgical opening in the neck for a breathing (endotracheal) tube into the patient's airway (trachea). This tube is attached to a mechanical ventilator (breathing machine) or an oxygen mask to help the patient breathe.
Ventilators for home use are small, lightweight and run on electricity. They can be powered by the internal battery for brief trips outside the home, and can sit on a bedside stand, cart or wheelchair and be used for travel. Most feature various levels of gas/air-flow pressure, volume, rate and duration to control breathing or to wean a patient off the ventilator.
The two main categories of ventilators include:
These devices provide breathing support through an external interface, such as a mask or nasal prongs.
Patients on long-term ventilation may require ventilation through an endotracheal tube inserted through the mouth or nose, or through a tracheostomy tube inserted into an incision in the in the neck.
Volume-cycled ventilators deliver a preset volume of gas/air or “tidal” volume and then allow passive exhalation. This type is ideal for patients with acute respiratory distress syndrome or bronchospasm, since the same tidal volume is delivered regardless of airway resistance or compliance.
Pressure-cycled ventilators deliver gases at a preset pressure and allow passive exhalation. The benefit is a decreased risk of lung damage from high inspiratory pressures. The disadvantage is that the tidal volume delivered can vary with changes in lung resistance and compliance if the patient has poor lung compliance and increased airway resistance.
This ventilator is often used for short-term therapy. Some have the capability to provide both volume-cycled and pressure-cycled ventilation. These combination ventilators are also commonly used in critical care environments.
Flow-cycled ventilators deliver oxygenation until a preset flow rate is achieved during inhalation.
Time-cycled ventilators deliver oxygenation over a preset time period. The ventilators are not used as frequently as the volume-cycled and pressure-cycled ventilators.
Continuous positive airway pressure ventilators
Continuous positive airway pressure ventilators increase the work of breathing by forcing the user to exhale against resistance. This ventilator provides a continuous flow of air at the same level of pressure during inhalation and exhalation to help keep the airway open. This is especially helpful for obstructive sleep apnea. But this is not considered a true ventilator because it doesn’t assist with breathing.
Bi-level positive airway pressure ventilators
Bi-level positive airway pressure ventilators deliver air at two pressures for inhalation and for exhalation. This type of ventilator helps treat neuromuscular disease with a spontaneous timed mode or backup rate that initiates breaths, particularly at night.
A variety of nasal or facial masks and attachments are available, and can be customized for the best fit.