Why ventilators are so crucial in treating COVID-19 patients

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TORONTO — As cases of the novel coronavirus continue to rise across Canada, many health workers are calling on the federal government for support in providing medical supplies and personal protective equipment to help them take care of patients.

Among the much-needed equipment are breathing machines, also known as mechanical ventilators.

WHAT ARE VENTILATORS?

Mechanical ventilators are machines attached to patients, either via a tube inserted through the mouth and into the throat, or they can be used with a tight-fitting mask that goes around the nose and mouth.

The machine forces air into patients, providing extra oxygen to support their breathing muscles. This allows the patient to relax and exhale.

Dr. Irvin Mayers, professor of medicine at the University of Alberta, says patients with COVID-19 might require a ventilator because they can develop severe respiratory illnesses, most commonly pneumonia.

He says patients aren’t able to breathe because of an inflammation that disrupts their air passage.

“The body’s response to the infection is with a lot of inflammation and it’s the inflammation in the air passage that seems to give all the problems, so you can support people with their breathing until this settle,” he told CTVNews.ca on Tuesday.

WHY ARE VENTILATORS IMPORTANT?

The ventilators inserted through a tube, known as invasive ventilators, are crucial in preventing infection built up in the patient’s air passage, according to Mayers.

A patient’s breathing can fail in two ways. When the breathing muscles get exhausted from working hard to move air in, carbon dioxide builds up and can cause the blood stream to become acidic, resulting in organ failure.

Or, the air passage can become infected with fluids, preventing oxygen from getting into the blood stream. In some worse cases, both can happen at the same time.

“The ventilator, by supporting your breathing muscles, can help you get rid of the excess carbon dioxide and by increasing the amount of oxygen you breathe in can help overcome the air passage filling with fluid or infection,” said Mayers.

Dr. John Granton, head of respirology for the intensive care unit at Mount Sinai’s University Health Network, said while ventilators are expensive – with prices averaging in the tens of thousands of dollars -- they allow physicians to directly attack a patient’s breathing issues.

“They are complex computers; they have a lot of features which allow us to individualize our care for each patient that comes our way,” he told CTVNews.ca on Tuesday.

WHAT ARE THE CHALLENGES?

For health-care workers, ventilators can be difficult to set up for patients, especially those with an infectious virus.

“It is more challenging because you do have to dress up properly to make sure your skin, and more important your eyes, nose, lips and mouth are all covered so that if there’s any droplets sprayed it wont reach those parts of your body, much like a sneeze,” said Granton.

Health-care workers must wear masks, face shields and gowns to protect themselves from this infectious virus. That’s why Granton says personal protective equipment is so important and why many health workers have concerns over potential shortages.

WHO GETS A VENTILATOR AND FOR HOW LONG?

According to Mayers, there are no concrete projections that has determined how many patients with COVID-19 will require a ventilator. However, current estimates guess that not all patients with COVID-19 will require these breathing machines.

“It varies a lot from country to country, when you look at some places the rate of needing intensive care is low and in others it’s high and it’s not clear why. The majority are not going to go on a ventilator and with COVID-19, going on a ventilator means you’re really sick, and unfortunately those are the people who may succumb,” said Mayers.

“Some of the guesses for Canada would be about 15 per cent of people with COVID-19 infections will get into hospital and maybe five per cent will need a ventilator. Those are guesses but that might give people the idea that getting COVID-19 doesn’t mean you’ll be in intensive care and on a ventilator,” he said.

Mayers said it all depends on the region and more importantly a patient’s health conditions, age and risks.

Depending on the severity of the patients’ condition, some could be on a ventilator for a few days or even weeks.

WHAT'S IT LIKE?

Relying on an invasive ventilator can be as uncomfortable as it looks, according to Granton. He says most patients can become anxious about their illness and having to rely on a large machine, so physicians often have to sedate them to help them relax.

In some severe cases, patients are put in a medically-induced coma to help them relax their muscles and breathe normally.

“They can’t speak when the tube is in because it goes past their voice box so its frustrating when they begin to wake up. The other thing they can’t do is eat and swallow, so we actually have to put feeding tubes down into their nose and mouth and into their stomach so we can give them nutrition that way,” he said.

While ventilators are crucial in treating COVID-19 patients, Granton said it’s important to note that ventilators are not able to cure viral infections but can only support the body as it fights off the infection.

“Breathing machines are really there to cradle and support the person through the infection as they would carry them through surgery until they get better,” said Granton.

“We are looking at treatments for the COVID-19 infection but most of those are experimental and are being developed right now, but there is a huge global effort to evaluate different treatments,” he said.