Overview
At this point it is necessary to give your relative or loved one artificial ventilation. A ventilator will temporarily support or take over breathing. This can be for several reasons. You will be informed about this by the doctor of the Intensive Care Unit. In this folder you can read about ventilation and its consequences for the patient.
What is ventilation?
The ventilator is placed next to the patient at the head of the bed. The patient is connected to this machine through a number of hoses and a tube. This tube is in most cases inserted into the mouth, in a few cases into the nose, and continues into the patient’s windpipe. This tube is called tube (pronounced ‘tjoep’). The ventilator takes over the patient’s inhalation and exhalation. This can be to support the breathing, but it is also possible that the machine takes over the entire breathing. The presence of the tube and the ventilation itself can be annoying for the patient. Therefore, the patient is sometimes given sleeping medication. This can vary from a light sleep where the patient is awake, to a deep sleep. In addition to these sleep medicines, the patient often also receives painkillers. In a few cases, muscle relaxant drugs are administered. As a result, the patient can no longer move and is completely limp. The ventilation has temporary consequences for the care and approach of the patient. We have listed these consequences for you.
Communication
Because of the sleeping medicines, personal contact with the patient is difficult or even impossible. Yet there is a chance that he or she will still hear and feel things. You often see the nurse just talking to the patient. You too can just talk to the patient, touch him or her or give him a kiss. When the sleep medication is no longer needed, the patient will gradually wake up. He or she can then react to the environment but not yet talk. This is due to the position of the tube (see drawing in the section Food and drink). The tube runs between the vocal cords through the trachea. Attached to the tube is a small balloon called a cuff. This balloon ensures that all the air that is exhaled is discharged through the tube. The tube and the cuff prevent the vocal cords from vibrating and talking becomes impossible. However, it is possible to communicate with the patient in other ways.
We give you some suggestions:
- You can ask specific (closed) questions to which the patient can nod yes or shake no.
- You can speak and the patient can write ‘back’. In a number of cases this is difficult for a patient because his or her motor skills are not optimal. Use keywords instead of whole sentences. This is also less tiring.
- The patient can point to letters on a letter board to form words. Again, it is better to use keywords. If you want to use the letter board, you can ask a nurse.
- In some cases you can lip-read the patient. This can be difficult due to the presence of the tube in the mouth. Try again to think of keywords, for example ‘thirst’ or ‘pain’.
- The patient can also type letters on an I-pad via a special app. An I-pad is available in the Intensive Care Unit. Ask the nurse if you want to use it. Again, this method works best if you use keywords rather than entire sentences.
Distraction Providing distraction while the patient is awake is usually very much appreciated. Due to the distraction, the patient is briefly occupied with something other than being ill and his or her stay in the Intensive Care Unit. You can provide distraction in the following ways:
- You can talk to the patient about everyday things, such as the home situation.
- You can bring a discman and CDs or an Ipod with the patient’s favorite music.
- You can bring and hang pictures of the patient’s relatives or loved ones.
- You can read to the patient.
Care of the patient
A patient on a ventilator is unable to cough up the mucus from his lungs himself because of the tube and the possible sleep state. It is imperative that the nurses suck out this mucus. This can give the patient a stuffy appearance. Some people find this an unpleasant sight. If you want to wait in the hallway during this operation, you can of course always indicate that.
When a patient is on a ventilator and has a tube in it, normal eating and drinking is not possible. This is to prevent the patient from choking. In addition, swallowing movements can damage the vocal cords (see drawing).
The patient receives nutrition through a gastric tube, the so-called tube feeding. This is a complete diet that contains all the necessary nutrients and moisture. This liquid food is normally absorbed and tolerated by the body. In some cases, this tube feeding is not possible either. This may be because the patient’s intestines are not yet working after surgery. It may also be that the intestines should not be burdened with food.
In these cases, the patient receives nutrition through an IV. In this way, the nutrients are delivered directly into the bloodstream. This is also a complete food. Weaning off the ventilator When the patient’s condition improves, he or she will have to ‘learn’ to breathe again. We call this process weaning off the ventilator. How long this process takes varies from person to person. There is no exact time frame for this. In general, the withdrawal period is shorter if the period of ventilation has also been short. After prolonged ventilation (five days or more) it is usually necessary to gradually reduce the support of the machine so that the patient starts to breathe more and more on his own. Eventually, in most cases, the patient will be able to breathe without a machine again. When that moment has come, the tube is removed. Some patients are hoarse for a few days afterwards. Finally If you have any questions or problems, you can always contact the nurses or doctors of the Intensive Care Unit.
