Sunday, April 5, 2020

How serious is being put on a ventilator?

A lot of it, depends on the why. Being put on a ventilator normally means that for some reason, you are unable to support your own breathing. Pretty serious stuff.
Being placed on a ventilator is no walk in a park. First you must be intubated.
A tube is inserted down your throat, into your lungs. This is invasive in its own right. Everything is supposed to be sterile, but once it hits your mouth and throat, all bets are off. This is a serious matter.
Then you are placed on the vent. There are various settings, rate, volume, peep, pressure, FI02. etc. All these work to breathe for you, or assist your breathing at other times. (Assist/Control)
You are generally kept sedated and tied down, so you don’t wake up and pull your trach tube out. You typically cannot communicate, other than perhaps writing. IF you are allowed to wake enough for that.
Then once the critical stage is passed, you are weaned. The rate is turned down, you begin to take on more and more of the work of breathing. If you meet the parameters, you’ve shown you should be able to breath on your own. You are then extubated, (tube pulled out) and you are generally placed on oxygen.
There are some patients who cannot meet the parameters of being extubated. Maybe they have a lung disease, or some other factor. It might then be decided (generally by the doctor, patient and or family) that they will be extubated and let to sink or swim. This is rare, in my experience, but it does happen. Generally it’s those people who decide they don’t want to be on a ventilator permanently
A lot of people if not most who get CABG (coronary arterial bypass grafting) come out of surgery on a ventilator. These are aggressively weaned off, sometimes in just a few hours. Generally within a day.
Others, with some sort of lung issue, COPD (Chronic Obstructive Pulmonary Disease) may be on for a few days, to a week, depending on what the underlying problem is.
In general most every one who goes on a vent is put on as a life supporting event. Most people who go on, get better and come off within a week, usually less.
That being said, the patients who get Covid 19 and have to go a vent, are generally on it for 2 to 3 weeks. It’s my understanding about half of these patients who go on a vent die. That is an amazing statistic. If you have Covid 19 and need to go on a vent, you are on 3 or 4 times longer then average, with a much higher rate of death. This is what is making the ventilator shortage critical.
I believe it’s in Italy that the shortage is so bad, that anyone over 60 will not be placed on a vent. As I am currently 61, this one strikes home HARD!
(I have been informed that this is not correct. My relief and my thanks to Giovanni Piccioli for correcting me. I am glad this is not the case!)
(Done on my phone, so probably will have errors, spelling, punctuation, etc. sorry in advance)
(Gregorio Morales suggested an edit, which I accepted. Thank you!)

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