When should a COVID-19 patient go on a ventilator?

When COVID-19 causes ARDS, a ventilator is needed to help the patient breathe. ARDS reduces the lungs’ ability to supply oxygen to vital organs

According to the World Health Organization, 1 in 6 COVID-19 patients become seriously ill and have difficulty breathing, as the virus primarily affects the lungs. Infected or damaged lungs are less efficient at transporting oxygen from the air to the bloodstream.

If your immune system fails to fight off the infection, it can spread to the lungs and cause acute respiratory distress syndrome (ARDS), which is a life-threatening illness.

When COVID-19 causes ARDS, a ventilator is needed to help the patient breathe. ARDS causes severe inflammation of the lungs and causes fluid to build up in the alveoli, which are tiny air sacs in the lungs that transfer oxygen to the blood and remove carbon dioxide. This reduces the ability of the lungs to supply sufficient oxygen to vital organs.

Other indications for starting ventilation in a patient include:

  • Bradypnea (unusually slow breathing)
  • Apnea (stopping breathing)
  • Tachypnea (abnormally rapid breathing)
  • Inefficient gas exchange
  • Fatigue of the respiratory muscles

What are the potential complications of intubation?

Sedation is required for ventilation, during which a breathing tube is placed into the patient’s trachea by intubation. Doctors monitor the pressure and the amount of oxygen delivered by the ventilator.

Complications can occur with intubation or ventilation, which can sometimes be life threatening.

Complications of intubation

  • Trauma to the upper airways and nose
  • Tooth displacement (avulsion)
  • Injury to the mouth, throat, vocal cords or windpipe
  • Prolonged intubation can cause:

Ventilation complications

  • Ventilator-induced lung injury resulting in alveolar rupture and lung collapse
  • Oxygen toxicity due to excess oxygen
  • Ventilator-associated pneumonia caused by lung infections
  • Side effects and drug reactions
  • Adverse effects on the bloodstream, heart, kidneys and abdomen
  • Fan malfunction
  • Inability to wean off the ventilator
  • Sepsis

Why do some COVID-19 patients need oxygen support?

The coronavirus is primarily a respiratory virus that severely impairs lung function. Inflammation in the lungs and airways can reduce the flow of oxygenated blood throughout the body, causing the patient to gasp in breath.

Normal oxygen saturation levels vary between 94% and 99%. When SPo2 levels drop below 93%, this is a sign that oxygen therapy is needed. Oxygen therapy is beneficial in cases where a patient has:

  • Pneumonia or ARDS
  • Dyspnoea (severe shortness of breath)
  • Hypoxia (oxygen deprivation in tissues without the presence of other physical symptoms)

Based on current clinical management guidelines, supplemental oxygen may be administered at home or in a hospital setting, depending on the patient’s condition and other symptoms. An oxygen supply may be provided for an extended period depending on the severity of the disease.

Why are there different types of breathing aids for patients with COVID-19?

Patients with severe COVID-19 may require respiratory assistance to maintain optimal oxygen saturation. The amount of oxygen required is determined by the patient’s oxygen levels and the severity of the symptoms. Based on clinical management protocols, patients typically require an oxygen flow rate of 5 L / min. Some patients, however, may end up using less oxygen (2-3 L / min).

Respiratory aids available to COVID-19 patients include:

  • Oxygen therapy: The main reason for being admitted to hospital with COVID-19 is to receive supplemental oxygen, which increases the amount of oxygen in the lungs and blood. Supplemental oxygen can be administered through the nose with a plastic tube or through a loose face mask.
  • Continuous Positive Airway Pressure (CPAP): If breathing extra oxygen is not enough to increase the oxygen level in the patient’s blood, CPAP therapy can be used to help deliver oxygen through a properly fitted mask that is connected to a machine by plastic tube. The patient stays awake and doctors can monitor the pressure and the amount of oxygen being delivered. However, this treatment requires a large amount of oxygen, which can be scarce in hospitals treating large numbers of COVID-19 patients.
  • Invasive mechanical ventilation (IMV): A small percentage of critically ill COVID-19 patients are placed on a ventilator. With IMV, a machine breathes for the patient. Some ventilated patients benefit from positioning on the chest and stomach, perhaps because this opens up the lungs more and thus allows better gas exchange between the air and the bloodstream. Patients who only need basic oxygen therapy may benefit from this position.
  • Extracorporeal membrane oxygenation (ECMO): ECMO is used to treat a very small number of critically ill patients whose lungs have been severely damaged but who were otherwise fit and healthy before COVID-19. This treatment requires the use of a machine that consists of two parts: a pump that moves blood between the body and the machine, and a membrane that acts like an artificial lung and allows the body’s lungs to rest, their giving a better chance of recovery. It is only available in a few specialist centers across the country.

What is the outcome of patients who need ventilators due to COVID-19?

As many countries scramble to get enough of these life-saving machines, ventilators have become a focal point of the coronavirus pandemic. For patients who need a ventilator, it can often mean the difference between life and death.

However, for the 50% who survive and eventually stop ventilation, many face a long, slow and traumatic recovery period from the disease and its treatment. Due to the high level of medical intervention required, those who abandon a ventilator typically require physical therapy to master basic functions such as swallowing, speaking, breathing, and walking. Recovery can include periods of confusion, disturbed thinking, hallucinations, anxiety, and depression.

These effects are in addition to the potential long-term damage to several organ systems from complications from the coronavirus. New evidence suggests that COVID-19 can affect the liver, heart, kidneys, intestines, and brain, in addition to the respiratory system.

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Medical examination on 1/10/2022

The references

Image source: iStock Images

Fans and COVID-19: What you need to know: https://www.yalemedicine.org/news/ventilators-covid-19

Oxygenation and ventilation: https://www.covid19treatmentguidelines.nih.gov/management/critical-care/oxygenation-and-ventilation/

COVID-19: https://iris.paho.org/bitstream/handle/10665.2/52577/PAHOIMSEIHCOVID-19200012_eng.pdf

COVID-19: Management of the intubated adult: https://www.uptodate.com/contents/covid-19-management-of-the-intubated-adult

Results of mechanically ventilated patients with respiratory failure associated with COVID-19: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242651

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