Ventilators (AKA: Breathing Tubes)
-Tube sits in the trachea
-Tube keeps air from going into the stomach
-Ventilator can breath for you, or assist your own breaths.
What are Breathing Tubes?
We'll start by explaining what breathing tubes are. The idea behind them is a very simple one. A tube is placed into your trachea, which is where air moves into and out of your lungs. A balloon is then inflated to close off the esophagus where food and water move into your stomach. This is done to keep the ventilator from pushing air into your stomach instead of your lungs.
The ventilator itself has many, many different modes and settings. Basically, though, if you're unconscious and unable to breathe on your own, the machine will breath for you. Once you're awake, it's possible to change the settings so that it doesn't force you to breathe, but instead just supports your own breaths.
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-Typically not painful
-Can sometimes gag you
-Can be uncomfortable when breathing for you
What do ventilators feel like?
Waking up with a breathing tube in isn’t going to be comfortable. It will be much more bearable, though, if you can stay calm and follow the instructions from your nurse. Typically, you won’t be on a breathing tube and awake very long. In fact, you’ll be woken up with the express purpose of attempting to pull the breathing tube out.
So, what’s it going to feel like?
I can only speak second hand to the sensation of the breathing tube, but I’ll do my best to relate the experience from the many former patients I’ve talked to about this.
It isn’t painful, it just isn’t comfortable. If you have a strong gag reflex, moving your head much can set off your gag reflex due to the tube moving just a little. It’s also a completely foreign experience, as you’ll only be able to pull air in through the tube itself. This is kind of like if you were trying to breathe through a water hose. It just won’t feel like you’re getting as much air.
And, likely the worst part, is that at first, it will force you to take breaths. The positive side of this is that once they begin testing you to see if you’re ready for it to be removed, you’ll pull your own breaths. It won’t make you take any more.
-Suctioning prevents secretion buildup
-Oral care prevents pneumonia
Hygiene on the Ventilator
One of the biggest risks with a breathing tube is something called ventilator associated pneumonia. It’s basically where, because we have this artificial path into your lungs, you get pneumonia. There are a few ways to offset this risk, and they probably aren’t going to be much fun.
The first is suctioning. We basically just run a small(er) tube through the breathing tube, apply suction, and pull it out. This allows us to pull out all the junk you would be coughing out, but aren’t able to because of the breathing tube. This ends quickly, but for a moment, it’ll take your breath away (literally.. and not the fun type).
The second is strong oral care. This means we’re going to brush your teeth every 2-4 hours (depending on the facility), and suction the back of your throat. You probably won’t enjoy the suctioning part, but the oral care will feel great since your mouth is going to be very dry.
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-Time varies for testing
-Better for you to be calm and patient
Removing the Breathing Tube
The testing to make sure you’ll do OK on your own varies quite a lot from place to place. Some hospitals will take as little as 30-60 minutes. It’ll be as simple as waking you up, letting you breathe on your own for 30 minutes, and drawing some blood to see what your oxygen and carbon dioxide levels look like. If all looks good, the tube is taken out.
At other hospitals, they’re much more careful. I've seen the process take as long as 4-5 hours (this was only at one particular hospital, most aren't so stringent). In either case, if you get worked up, breathe too fast, start to freak out, etc, it will change how long it takes to pull the tube out.. and not for the better!
I know what you’re thinking, they’ll either take it out, or I will. Well, here’s another fun aspect of a breathing tube..
-Your wrists will be restrained for your own protection
-Complications of putting a new tube in are worse than leaving the ventilator on
-Be patient, we want the tube out too
Restraints: Leave the Tube Alone
While you’re on the ventilator, you’ll likely have wrist restraints on. Why, you ask? For every ten patients that wake up on a ventilator, nine immediately reach for and try to pull out the breathing tube. It’s a natural, and extremely common, first reaction.
So your wrists will be tied, but would it really be so bad if you did get your hands on the tube? In short, yes. And again, YES!!
You’re more likely to have bad respiratory problems from pulling the tube out yourself than when we put the tube in. There’s a balloon that holds the tube in the right place, and if you pull it out with the balloon full, it can cause something called a laryngospasm. That means that your breathing hole closes and, as you can imagine, this is a very bad thing. Life threatening, in fact.
And that’s just one potential problem. So, you feel ready for it to come out, but everybody feels that way. What if you aren’t? When you go into respiratory distress (you aren’t getting enough oxygen and starting to freak out), we’re going to have to put the tube back in. That means another round of full sedation, chemical paralysis, and potential trauma/pneumonia from putting the tube in.
In the hospital setting, it's better for you and us to remove the breathing tube ASAP, but if we can’t, it’s because you just aren’t ready. Having it in longer increases your risk of pneumonia and other problems. If we’ve decided not to pull the tube out immediately, trust that the risks of pulling it out outweigh the risks of leaving it in.