Ventilators in the Time of COVID-19


By Trang Truong


The topic of “ventilators” has dominated news headlines as the number of COVID19 cases continues to rise, especially as doctors in the US experience shortages of said machines and general Personal Protective Equipment (PPE). However, these conversations beget the question: what exactly does a ventilator do, and how does it relate to COVID-19?

One of the hallmark symptoms of infection by COVID-19 is difficulty in breathing and shortness of breath. A recent study found that more than 40% of infected patients develop Acute Respiratory Distress syndrome (ARDS), a condition where fluid builds up in the tiny air sacs (alveoli) in the lungs. Risk factors for ARDS include sepsis (widespread infection of the bloodstream) and a history of chronic alcoholism. In the most severe cases of COVID-19, doctors put patients on invasive mechanical ventilators in order to help them breathe. While there are non-invasive ventilators as well, these are only recommended for patients with chronic lung or heart disease.


For invasive ventilators, patients are first sedated, and their breathing is temporarily stopped with the medical administration of a paralytic.

Then, an endotracheal (ET) tube is inserted through the nose, mouth, or into the trachea; this process is called intubation (see figure on right). The ET tube is then connected to a machine called a ventilator, which pumps oxygen through the tube directly into the lungs and maintains a constant level of lower air pressure in order to keep alveoli (tiny air sacs in the lung) from collapsing. The process also removes carbon dioxide from the lungs, allowing the patient to “exhale.”


As with every medical procedure, there are risks associated with using a ventilator. The ET tube can introduce another pathway for germs to directly enter the lungs, causing ventilator-associated pneumonia. The amount of inflammation in the patients’ lungs due to COVID-19 may also require patients to need dangerously high levels of oxygen and pressure from the ventilator. These forced conditions may lead to worsening lung function. Furthermore, early studies are seeing that there may be lower survival rates associated with patients placed on ventilators, leading some doctors to question whether decisions to use ventilators are being made too hastily.


In spite of the growing subjectivity of their efficacy, health professionals are facing an objective shortage of ventilators across the US. Previous papers on the US’s medical capacity during a pandemic actually predicted such shortages and the inevitable ventilator rationing decisions that physicians would be forced to make. In Italy, doctors have been pushed to their ethical limits as they are forced to decide “whom [they] shall keep alive” in the wake of ventilator shortages. In an attempt to overcome shortages, the Trump administration invoked the Defense Production Act in March of 2020 and focused federal government efforts towards the production of critical medical supplies including ventilators. Under this act, the Department of Health and Human Services announced contracts with companies such as Philips to produce tens of thousands of ventilators by the end of 2020.


Although these are unprecedented times, individuals can take action to combat this disease. In addition to staying home, individuals can help advocate to combat shortages in their local communities. On our website, the Policy Committee of Students vs Pandemics has outlined initiatives occurring at both the local and federal government levels that anyone can learn about and take part in. These include efforts to inform local representatives of how funding should be allocated and which areas need equipment such as masks and ventilators most. Together through community-driven efforts, we can all help medical professionals get the supplies they need to treat COVID-19 patients and change the course of this pandemic.



Results from ongoing research and the current understanding of COVID-19 are constantly changing and growing. This post contains information that was last updated on April 22, 2020.


Sources:

1. https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963

2. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2763184?appId=scweb

3. https://www.mayoclinic.org/diseases-conditions/ards/symptoms-causes/syc-20355576

4. https://youtu.be/ylpSy1OZP8k

5.https://www.thoracic.org/patients/patient-resources/resources/mechanical-ventilation.pdf

6.https://www.npr.org/sections/health-shots/2020/04/02/826105278/ventilators-are-no-panacea-for-critically-ill-covid-19-patients

7. https://www.atsjournals.org/doi/full/10.1164/rccm.201509-1810ED

8. https://doi.org/10.1016/S2213-2600(20)30110-7

9. https://time.com/5820556/ventilators-covid-19/

10. https://www.nejm.org/doi/full/10.1056/NEJMp2006141

11. https://dx.doi.org/10.1007%2Fs10728-010-0148-6

12. https://www.nejm.org/doi/full/10.1056/NEJMp2005492

13.https://www.hhs.gov/about/news/2020/04/08/hhs-announces-ventilator-contract-with-philips-under-defense-production-act.html

14.https://www.winchesterhospital.org/health-library/article?id=112024

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