What Is Kidney Failure?

Kidney disease comes in five stages. Stage 5 (also known as end stage renal disease, or ESRD) is when kidneys
function below 10 to 15 percent of their normal capacity. This essentially is known as kidney failure.
In most cases, kidney failure occurs after years of having chronic kidney disease (CKD). Less common is acute
kidney failure, a sudden stop of kidney function. Whichever the case may be, it is vital that a person with kidney
failure receives a kidney replacement treatment to stay alive.
You have options when it comes to treating kidney failure, the most common of which isdialysis. If you and your
doctor find that a kidney transplant is the right treatment for you, you will still need dialysis while waiting for a
matching kidney donor. DaVita offers several dialysis choices that can suit your lifestyle:
In-center hemodialysis
Get treatments at a dialysis center from caring kidney care professionals and interact with other
patients.
Peritoneal dialysis (PD)
Do shorter treatment cycles when you dialyze at home or work on this needle-free treatment.
Home hemodialysis (HHD)
Perform hemodialysis in the privacy of your own home, with a trained care partner to help you with
treatments.
In-center nocturnal hemodialysis
Turn sleep time into dialysis treatment time when you stay overnight at the dialysis center.
In-center self care hemodialysis
Receive training from your kidney care team to become more hands-on when you get dialysis
treatment at the center.

How Does a Ventilator Work?

Ventilators blow airor air with extra oxygeninto the airways and then the lungs. The airways are
pipes that carry oxygen-rich air to your lungs. They also carry carbon dioxide, a waste gas, out of your
lungs.

The airways include your:

Nose and linked air passages, called nasal cavities

Mouth
Larynx (LAR-ingks), or voice box
Trachea (TRA-ke-ah), or windpipe
Tubes called bronchial tubes or bronchi, and their branches
For more information about the airways, go to the Health Topics How the Lungs Work article.

The Breathing Tube

A ventilator blows air into your airways through a breathing tube. One end of the tube is inserted into
your windpipe and the other end is attached to the ventilator. The breathing tube serves as an airway
by letting air and oxygen from the ventilator flow into the lungs.

The process of inserting the tube into your windpipe is called intubation (in-too-BA-shun). Usually, the
breathing tube is put into your windpipe through your nose or mouth. The tube is then moved down
into your throat. A tube placed like this is called an endotracheal (en-do-TRA-ke-al) tube.
In an emergency, you're given medicine to make you sleepy and ease the pain of the breathing tube
being put into your windpipe. If it's not an emergency, the procedure is done in an operating room
using anesthesia. (That is, you're given medicine that makes you sleep and/or causes a loss of
feeling.)

An endotracheal tube is held in place by tape or with an endotracheal tube holder. This holder often is
a strap that fits around the head.

Sometimes the breathing tube is placed through a surgically made hole called atracheostomy (TRA-ke-
OS-to-me). The hole goes through the front of your neck and into your windpipe. The tube put into
the hole sometimes is called a "trach" tube.

The procedure to make a tracheostomy usually is done in an operating room. Anesthesia is used, so
you won't be awake or feel any pain. Specially made ties or bands that go around the neck hold the
trach tube in place.

Both types of breathing tubes pass through your vocal cords and affect your ability to talk.

For the most part, endotracheal tubes are used for people who are on ventilators for shorter periods.
The advantage of this tube is that it can be placed in an airway without surgery.

Trach tubes are used for people who need ventilators for longer periods. For people who are awake,
this tube is more comfortable than the endotracheal tube. Under certain conditions, a person who has
a trach tube may be able to talk.

The Ventilator

A ventilator uses pressure to blow air or a mixture of gases (like oxygen and air) into the lungs. This
pressure is known as positive pressure. You usually exhale (breathe out) the air on your own, but
sometimes the ventilator does this for you too.

A ventilator can be set to "breathe" a set number of times a minute. Sometimes it's set so that you
can trigger the machine to blow air into your lungs. But, if you fail to trigger it within a certain amount
of time, the machine automatically blows air to keep you breathing.

Rarely, doctors recommend a ventilator called a chest shell. This type of ventilator works like an iron
lungan early ventilator used by many polio patients in the last century. However, the chest shell isn't
as bulky and confining as the iron lung.

The chest shell fits snugly to the outside of your chest. A machine creates a vacuum between the shell
and the chest wall. This causes your chest to expand, and air is sucked into your lungs. No breathing
tube is used with a chest shell.

When the vacuum is released, your chest falls back into place and the air in your lungs comes out.
This cycle of vacuum and release is set at a normal breathing rate.

What To Expect While on a Ventilator

Ventilators normally don't cause pain. The breathing tube in your airway may cause some discomfort.
It also affects your ability to talk and eat.
If your breathing tube is a trach tube, you may be able to talk. (A trach tube is put directly into your
windpipe through a hole in the front of your neck.)

Instead of food, your health care team may give you nutrients through a tube inserted into a vein. If
you're on a ventilator for a long time, you'll likely get food through a nasogastric, or feeding, tube. The
tube goes through your nose or mouth or directly into your stomach or small intestine through a
surgically made hole.

A ventilator greatly restricts your activity and also limits your movement. You may be able to sit up in
bed or in a chair, but you usually can't move around much.

Patient on a Ventilator

The illustration shows a standard setup for a ventilator in a hospital room. The ventilator pushes
warm, moist air (or air with increased oxygen) to the patient. Exhaled air flows away from the
patient.

If you need to use a ventilator long term, you may be given a portable machine. This machine allows
you to move around and even go outside, although you need to bring your ventilator with you.

Sometimes the ventilator is set so that you can trigger the machine to blow air into your lungs. But, if
you fail to trigger it within a certain amount of time, the machine automatically blows air to keep you
breathing.

Ongoing Care

While you're on a ventilator, your health care team will closely watch you. The team may include
doctors, nurses, and respiratory therapists. You may need periodic chest x rays and blood tests to
check the levels of oxygen and carbon dioxide (blood gases) in your body.
These tests help your health care team find out how well the ventilator is working for you. Based on
the test results, they may adjust the ventilator's airflow and other settings as needed.

Also, a nurse or respiratory therapist will suction your breathing tube from time to time. This helps
remove mucus from your lungs. Suctioning will cause you to cough, and you may feel short of breath
for several seconds. You may get extra oxygen during suctioning to relieve shortness of breath.