The current COVID-19 pandemic has brought on a discussion about ventilator availability and every intensivist’s worst nightmare, the need for ventilator rationing. Most laypeople are familiar with ventilators (aka breathing machines) in the context of surgery. In the operating room, ventilators temporarily take over breathing for a patient, until the surgical procedure is completed. In the context of critical illness, the ventilator is a machine that works to support respiratory function until the patient recovers from their illness. The interface between the ventilator and the patient’s lungs is an endotracheal tube, which goes through the mouth into the trachea (aka the windpipe).
Patients with COVID-19 are at risk for developing respiratory failure, which is the inability to maintain the lungs two basics functions: breathing in (providing oxygen) and/or breathing out (getting rid of carbon dioxide). At one end of the spectrum of respiratory failure is the acute respiratory distress syndrome (ARDS), which implies a particularly severe difficulty in maintaining oxygen levels and diffuse lung damage. In two separate studies of patients hospitalized with COVID-19 in Wuhan, the incidence was 20% and 40%. Almost all patients with ARDS require ventilator support. It is impossible to predict how long each patient will require this ventilator support. It is also important to remember that the ventilator is not a cure for the underlying illness.
The exponentially increasing number of COVID-19 cases is taxing healthcare systems across the world as the number of available ventilators decreases. Without adequate ventilator supply, more people will die. Please help us avoid this dreary situation by washing your hands often (make sure you have proper technique), avoid touching your face/nose/eyes, clean and disinfect frequently touched surfaces), avoid close contact with others (don’t go out unless absolutely necessary, don’t meet up with friends/family, stay six feet away from others), cover your coughs and sneezes, wear a mask and stay home if you are sick. Further information about how to protect yourself and others is available on the CDC website.