Respiratory care refers to the treatment of disorders affecting a person's respiration, or ability to breathe. Both respiratory care practitioners and respiratory therapists see patients with a wide variety of breathing disorders, from asthma to diseases such as tuberculosis and emphysema.
For information please see Medical Ventilator.
For information please see Oxygen Concentrator.
BVM ventilation is used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately. It utilizes a self-inflating bag (resuscitator bag) attached to a nonrebreathing valve and then to a face mask that conforms to the soft tissues of the face. The opposite end of the bag is attached to an oxygen source and usually a reservoir bag.
CPAP is a type of non-invasive ventilation (NIV) or breathing support that uses mild air pressure to keep the airways open, typically used by patients who have breathing problems during sleep such as sleep apnoea. More specifically, CPAP therapy helps prevent airways collapsing when you breathe while asleep. CPAP machines are typically comprised of:
- A mask that covers your nose and mouth, a mask that covers your nose only, or even prongs that fit into your nose.
- A tube that connects the mask to the CPAP machine's motor.
- A motor that blows air into the tube.
ECMO machines provide respiratory and cardiac support by replacing the function of the heart and lungs. ECMO procedures are used for people whose
- lungs cannot provide enough oxygen to the body even when given extra oxygen
- lungs cannot get rid of carbon dioxide even with help from a mechanical ventilator
- heart cannot pump enough blood to the body
- support people with incurable heart or lung disease while they wait for an organ transplant.
Patients undergoing ECMO procedures are cared for in a hospital’s intensive care unit (ICU). Typically, ECMO machines are only employed for a few hours to days, but it can be utilized for several weeks, depending on how the patient’s condition progresses.
ECMO machines are connected to a patient through plastic tubes placed in large veins and arteries in the legs, neck or chest. The ECMO machine pumps blood from the patient’s body to an artificial lung (oxygenator) that adds oxygen to it and removes carbon dioxide. The oxygenated blood is then pumped back into the patient with the same force as the heart.
ECMO treatment for COVID-19
World Health Organization (WHO) interim guidelines recommend offering ECMO to eligible patients with acute respiratory distress syndrome (ARDS) related to COVID-19. The Extracorporeal Life Support Organization (ELSO) website is compiling a resource for centers who may be called on to manage COVID-19 patients. This includes a COVID-19 registry dashboard tracking the number COVID-19 patients who are or have received ECMO treatment.
Respiratory Dialysis is a simple, minimally invasive approach to extracorporeal carbon dioxide removal (ECCO2R) for patients with both acute and chronic respiratory failure. The growing interest in respiratory dialysis is due to its potential to minimize or avoid invasive mechanical ventilation and its associated consequences.
Consisting of the same circuit components as ECMO (e.g. cannulae, tubing, gas exchange membrane, and most frequently incorporating a centrifugal pump), the difference between ECMO and ECCO2R is that the intention of ECCO2R is specifically carbon dioxide removal without emphasis on oxygenation
ECMO is dependent on the amount of extracorporeal blood flow to saturate enough hemoglobin. This typically necessitates the use of large cannulae to achieve adequate blood flow to meet the needs of patients with severe hypoxemia. In contrast, carbon dioxide removal is much more efficient than oxygenation, allowing for the use of lower blood flow rates, potentially even within the range of what may be used for continuous venovenous hemodialysis (CVVH). With less demand for blood flow, ECCO2R can be achieved with smaller cannulae, comparable to dialysis catheters, which may have an improved risk-benefit profile compared to ECMO.
BCV is a non-invasive external ventilation technique that uses negative pressure breathing. A shell called a Cuirass is placed around the patient’s chest, attached to a power unit which actively controls both phases of the respiratory cycle. A negative pressure is generated within the chest cuirass, for inspiration or continuous inspiratory assistance. A positive pressure within the cuirass induces expiration.
Diaphragm pacing is an orphan surgical procedure that may be proposed in strictly selected ventilator-dependent patients to get an active diaphragm contraction. Its purpose is to wean patients from mechanical ventilation and restore permanent efficient breathing. It is a treatment option for some patients diagnosed with congenital central hypoventilation syndrome as well as those who have suffered a high cervical spinal cord injury.
Diaphragm pacer systems involves 4 components:
- electrodes that are surgically attached to the phrenic nerves on each side of the neck or in the chest,
- receivers that are surgically implanted in the abdomen or chest,
- antennae which are taped on the chest over the receivers during pacing,
- portable external transmitter machine.
The transmitter sends a signal to the receivers, the external transmitter generates electrical energy which the receiver converts to electrical current that is conducted to the phrenic nerves. The nerve stimulation causes the diaphragm muscles to contract and the person takes a breath in. This cycle repeats for the number of breaths needed each minute. A respiratory rate is set for the transmitter for how often to trigger a breath.
