When you hear the phrase life support, you often think of someone on the brink of death due to a severe illness or injury or someone who is hooked up to a machine that is helping him or her stay alive.

Life support is usually deployed as a short-term, temporizing measure to buy sufficient time for the patient to recover from a critical illness and be able to sustain life without help of life support devices.

Life support refers to the treatments and techniques performed in an emergency in order to support life after the failure of one or more vital organs. Healthcare providers and emergency medical technicians are generally certified to perform basic and advanced life support procedures; however, basic life support is sometimes provided at the scene of an emergency by family members or bystanders before emergency services arrive. In the case of cardiac injuries, cardiopulmonary resuscitation is initiated by bystanders or family members 25% of the time. Basic life support techniques, such as performing CPR on a victim of cardiac arrest, can double or even triple that patient's chance of survival. Other types of basic life support include relief from choking (which can be done by using the Heimlich maneuver), staunching of bleeding by direct compression and elevation above the heart (and if necessary, pressure on arterial pressure points and the use of a manufactured or improvised tourniquet), first aid, and the use of an automated external defibrillator.

The purpose of basic life support (abbreviated BLS) is to save lives in a variety of different situations that require immediate attention. These situations can include, but are not limited to, cardiac arrest, stroke, drowning, choking, accidental injuries, violence, severe allergic reactions, burns, hypothermia, birth complications, Drug addiction, and alcohol intoxication. The most common emergency that requires BLS is cerebral hypoxia, a shortage of oxygen to the brain due to heart or respiratory failure. A victim of cerebral hypoxia may die within 8–10 minutes without basic life support procedures. BLS is the lowest level of emergency care, followed by advanced life support and critical care.

Care plans are personalized for patient needs and are designed to deliver high quality, affordable, and easy to implement health services.

Clinical team

• 2 ICU trained nurses – 12 hours each
• 2 Nursing assistants – 12 hours each
• Physiotherapist (as advised by primary physician)
• Respiratory therapist (1-2 visits/week)
• ICU consumables
• Weekly clinical quality audits

ICU Infrastructure

• Ventilator
• Infusion pumps
• DVT Pump
• Other equipment as per clinical assessment by Priyojon doctor
• Home visit reports
• E-Monitoring

On condition

GCS: 8 or less | Vitals: Unstable | Mobility: Restricted | Ventilation: Dependent

Clinical team

• 2 ICU trained nurses – 12 hours each
• 2 Nursing assistants – 12 hours each
• Physiotherapist (as advised by primary physician)
• Respiratory therapist (1-2 visits/week)
• ICU consumables
• Weekly clinical quality audits

ICU Infrastructure

• BiPAP
• Infusion pumps
• DVT Pump
• Other equipment as per clinical assessment by Priyojon doctor
• Home visit report

E-Monitoring

Clinical team

• 2 ICU trained nurses – 12 hours each
• 2 Nursing assistants – 12 hours each
• Physiotherapist (as advised by primary physician)
• Respiratory therapist (1-2 visits/week)
• Weekly clinical quality audits

ICU Infrastructure

• Oxygen concentrator
• Other equipment as per clinical assessment by Priyojon doctor
• Home visit reports
• E-Monitoring

On condition

GCS: 10 or more | Vitals: Stable | Mobility: Restricted

There are many therapies and techniques that may be used by clinicians to achieve the goal of sustaining life. Some examples include:

• Feeding tube
• Total parenteral nutrition
• Mechanical ventilation
• Heart/Lung bypass
• Urinary catheterization
• Dialysis
• Cardiopulmonary resuscitation
• Defibrillation
• Artificial pacemaker

These techniques are applied most commonly in the Emergency Department, Intensive Care Unit and Operating Rooms. As various life support technologies have improved and evolved they are used increasingly outside of the hospital environment. For example, a patient who requires a ventilator for survival is commonly discharged home with these devices. Another example includes the now-ubiquitous presence of automated external defibrillators in public venues which allow lay people to deliver life support in a prehospital environment.

The ultimate goals of life support depend on the specific patient situation. Typically, life support is used to sustain life while the underlying injury or illness is being treated or evaluated for prognosis. Life support techniques may also be used indefinitely if the underlying medical condition cannot be corrected, but a reasonable quality of life can still be expected.

As technology continues to advance within the medical field, so do the options available for healthcare. Out of respect for the patient's autonomy, patients and their families are able to make their own decisions about life-sustaining treatment or whether to hasten death. When patients and their families are forced to make decisions concerning life support as a form of end-of-life or emergency treatment, ethical dilemmas often arise. When a patient is terminally ill or seriously injured, medical interventions can save or prolong the life of the patient. Because such treatment is available, families are often faced with the moral question of whether or not to treat the patient. Much of the struggle concerns the ethics of letting someone die when they can be kept alive versus keeping someone alive, possibly without their consent. Between 60 and 70% of seriously ill patients will not be able to decide for themselves whether or not they want to limit treatments, including life support measures. This leaves these difficult decisions up to loved ones and family members.

The best known life support device is a mechanical ventilation machine, which helps patients breathe when a patient’s lung is too sick to function on its own or when a patient is in too deep coma to effectively breathe.

Other life support methods include certain drugs that may artificially keep the blood pressure elevated, keep it from dropping to zero or keep the heart pumping adequately. Even in some severe disease conditions, emergent hemodialysis (the usual form of kidney dialysis used to clean the blood of toxins) can be a sort of life support tool. Then there are more advanced and complex life support machines that bypass the lung and the heart and take over these organs’ core functions. This sort of life support device, known as Extracorporeal Membrane Oxygenation (ECMO), is only available in specialized medical centers.

The physician at bedside decides when it is appropriate to put a patient on mechanical ventilation. The doctor considers when to initiate mechanical ventilation based on whether a patient is struggling to breathe on his or her own or whether the patient is able to maintain enough oxygen in his or her blood or exhale out enough carbon dioxide from the body. Also, when a patient is not alert and awake enough to breathe adequately or unable to handle the secretions, a doctor may also decide to put that patient on mechanical ventilation to prevent aspiration of secretions into the lung.

A patient is usually put to sleep when the breathing tube is inserted into the windpipe through the mouth. This is usually done at the bedside in the patient’s room. Once someone is on mechanical ventilation, he or she has to be in the ICU. Although in the past patients were kept in an induced coma while they were on mechanical ventilation, these days recent research suggests that it’s possible to keep patients comfortably awake and alert while they are on mechanical ventilation. At Orlando Health, we try our best to keep patients comfortable and as awake possible while they are on mechanical ventilation. If they aren’t comfortable, they are put on light induced sleep. 

When the tube is continued beyond two to three weeks, it’s no longer safe to keep it in mouth and it becomes necessary to do a tracheotomy, a procedure in which we make a hole in the front of the neck and insert a small tube into the windpipe to help the patient breath. A tracheotomy is much more comfortable than a breathing tube in the throat and the patient may even speak or eat while breathing through the tracheotomy tube. If there no longer is a need for the tube, it can be pulled out and the hole closes promptly.

An alternative to invasive mechanical ventilation is non-invasive ventilation, commonly known as BiPaP, which involves placing a large mask strapped tightly over the patient’s face and delivering pressurized air into the patient’s airway. We often use this approach for patients with COPD and heart failure. At Orlando Health, we often deploy non-invasive ventilation to prevent putting someone on invasive mechanical ventilation.

When someone is on mechanical ventilation, we instinctively try to see whether the patient can come off the ventilator. The moment a patient is put on mechanical ventilation; we begin trying to liberate the patient from the ventilation. We put the machine on its lowest setting to monitor how the patient breathes on his or her own. If the patient can breathe comfortably, the test will last 30 minutes for us to observe. If the patient cannot breathe without the help of the machine, he or she will remain on the ventilator. However, if someone can’t come off the ventilator in two or three weeks, then we perform a tracheotomy, which is done in the patient’s room so that it is much more comfortable.

Several types of conditions can cause breathing issues that require mechanical ventilation, including pneumonia, chronic lung failure and heart conditions. According to the American Association for the Surgery of Trauma, more than 790,000 hospitalizations in 2005 involved mechanical ventilation, and between 20 to 30 percent of patients admitted to the intensive care unit (ICU) required this kind of medical intervention, according to The Society of Critical Care Medicine (SCCM).

Being on a ventilator has its own consequences. Every day on a ventilator, patients are more at risk for ventilator-associated pneumonia. They also are at risk for blood clots and other complications like stenosis (narrowing arteries) and scarring. I often tell patients’ families that it’s not a matter of if, it’s a matter of when the next bout of infection will attack the patient. In many cases, such infections are the cause of death instead of the condition for which the patient was put on mechanical ventilation.

Life support helps many patients, especially when we use it as a short-term measure to aid their breathing. However, when life support is an option in critical care situations it often becomes a hot button issue, particularly among families. That’s why it’s important to discuss your end-of life wishes with your loved ones and make clear to them and your physician whether you would want mechanical ventilation if you’d never regain the ability to breathe on your own or return to an acceptable quality of life. For patients with serious lung diseases, having this conversation is a necessity.

Hopefully, no one you love ever has to go on life support.