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While the majority of the patients of COVID-19 infection suffer from mild symptoms of COVID-19 infection such as fever, cough and difficulty breathing, some of the patients also suffer from severe symptoms such as extreme difficulty in breathing, persistent pain in the chest, a state of confusion (delirium) and bluish discolouration of the face and lips. Patients who show these severe symptoms are prone to respiratory complications like viral pneumonia and pulmonary embolism. These people require mechanical ventilation for life support. 

A ventilator is an emergency respiratory machine that is used to provide breathing assistance to a person who cannot breathe on their own. A ventilator doesn't treat their disease or condition but provides oxygen to their lungs and removes carbon dioxide from their body. 

There two different types of ventilators that can be used for COVID-19 patients: negative pressure ventilators (non-invasive) and positive pressure ventilators (invasive). In most of the cases, positive pressure ventilators are used for critically ill COVID-19 patients. 

A ventilator is a complex machine which requires expertise for its management. The oxygen is delivered to the body of the infected patients with the help of tubes which are inserted in the nose and mouth of the patient. 

A nasogastric tube is inserted through the nose which goes till the stomach. This tube is used to deliver food to the patient’s body. Another tube called the endotracheal tube (ET tube) is inserted through the mouth of the patient to their windpipe (trachea) to transport oxygen to the lungs. The other end of the ET tube is attached to the ventilator. 

The ventilator transfers oxygen into the ET tube which delivers that oxygen to the lungs. Once the oxygen reaches the patient’s body, the ET tube receives carbon dioxide from the lungs. That is how the cycle continues. 

However, people who receive this mechanical ventilation are at an increased risk of getting the complications related to it. Here in this article, we will tell you about the risks of a ventilator in the patients with COVID-19 infection.

  1. Are there any risks of a ventilator for COVID-19 patients?
  2. What are the side effects of ventilators?

People with severe infection sometimes need mechanical ventilation as they are unable to breathe on their own. But according to a recent study published in the journal Jama on 22 April, it was concluded that people with severe symptoms of COVID-19 who required mechanical ventilation (ventilators) were at a higher risk of fatality than those who didn’t. 

The study conducted in New York City included 5700 patients who were hospitalized with the COVID-19 infection. The most common comorbidities in those patients were hypertension, obesity and diabetes. Most of these patients were in the age group of zero to 107 years of age and the major proportion of them were male. According to the requirement of the patients, 373 patients were admitted to the intensive care unit (ICU) for intense treatment while 320 were intubated and put up on a ventilator, and around 81 patients treated with kidney replacement therapy. About 553 people who were admitted to the hospital died due to severe complications.

Most of the people who were given mechanical ventilation were above 65 years of age and around 88.1% of them succumbed to complications. 

With this study, doctors concluded that COVID-19 infected people who receive ventilator support for breathing and are aged were at a higher risk of dying due to complications.

A ventilator is the most important machine for COVID-19 patients with severe levels of infection. It acts as life support but also carries a major risk of deadly infections. The most possible side effects of being on a ventilator are:

  • Pneumonia: The breathing tube makes it difficult for the patients to cough, which collects sputum in their airways. Moreover, the ET tube is inserted directly from the mouth to the lungs, so there is a major risk of transmission of bacteria directly into the lungs. This may lead to ventilator-associated pneumonia (VAP) which can deteriorate the condition of the patient and delay their recovery.
  • Sinus infection: Sinuses are empty cavities that are present to balance air in the body. If a person is on mechanical ventilation for a long period of time, these sinuses get infected or filled with fluid. This is known as ventilator-associated sinusitis and it is one of the common side effects of mechanical ventilation. 
  • Oxygen toxicity: Oxygen that comes from the ventilator may lead to the generation of free radicals like superoxide anion, hydroxyl radical, and hydrogen peroxide in the body. These free radicals can damage the lungs or other organs of the body.
  • Pneumothorax: Prolonged mechanical ventilation can lead to pneumothorax. Pneumothorax is a life-threatening condition where the air leaks from the lungs and gets stuck into the space between the chest wall and the lungs. A patient with pneumothorax may feel pain and severe shortness of breath. This condition can cause the lung to collapse. 
  • Lung damage: Prolonged mechanical ventilation can cause permanent damage to the lungs in the form of ventilator-induced lung injury. Lung injury can be caused either due to barotrauma (injury occurred during high ventilator volume) or atelectrauma (repeated injury or collapse of the alveoli).
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References

  1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. Published online April 22, 2020.
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