What is mechanical ventilation?
People with the most severe lung symptoms from COVID-19 coronavirus disease need mechanical ventilation to stay alive. Experts fear a shortage of breathing machines in the U.S., considering the pandemic.
Mechanical ventilation is a treatment to help a person breathe when they find it difficult or are unable to breathe on their own. A mechanical ventilator pushes airflow into the patient’s lungs to help them breathe.
Do you need mechanical ventilation if you have COVID-19 coronavirus?
Mechanical ventilation is part of the arsenal of supportive care clinicians use for COVID-19 coronavirus disease patients with the most severe lung symptoms.
A COVID-19 infection can cause fluids and mucus in the lungs that block oxygenation of lung tissue. Mechanical ventilation can help support COVID-19 patients' breathing until their immune system and treatment can clear the infection and proper lung function is restored.
Public health experts fear there is a shortage of mechanical ventilation machines in the U.S., considering the coronavirus pandemic.
Why is mechanical ventilation required?
Breathing is essential to get oxygen into the body and expel carbon dioxide. The lung normally performs this function by expanding and drawing in air and contracting and expelling it.
The lung has millions of tiny air sacs (alveoli) that transfer the oxygen into the blood supply that flows to the heart and remove the carbon dioxide from the blood flowing into the lungs from the heart. Certain illnesses prevent the lung from functioning normally.
Mechanical ventilation is required when:
- a patient needs assistance with breathing
- the patient’s respiration needs to be mechanically maintained
Mechanical ventilation assists lung function until ventilation is no longer needed. Mechanical ventilation helps in:
- relieving respiratory distress
- decreasing the work of breathing
- improving exchange of gases (oxygen/carbon dioxide)
- healing the lung
- reversing respiratory muscle fatigue
- allowing time for the patient to rest and recover
How is mechanical ventilation performed?
Mechanical ventilation may be performed invasively or noninvasively. Invasive ventilation is performed in the intensive care unit of hospitals. The two invasive methods of mechanical ventilation are:
- Endotracheal intubation: a tube inserted through the patient’s nose or throat.
- Tracheostomy: a tube inserted into a hole made in the patient’s throat.
Beside ventilation, the other benefits of intubation are:
- Bronchoscopy: examining the lung with a bronchoscope inserted through the breathing tube.
- Aspiration: suction of fluids to keep the airway clear.
- Medication: aerosolized medications more effectively delivered directly to the airway or lungs.
Noninvasive ventilation that can be administered at home or in the hospital are of three kinds:
- CPAP: Continuous positive airway pressure that delivers constant and steady air pressure.
- APAP: Autotritating (adjustable) positive airway pressure that changes air pressure according to the breathing pattern.
- BiPAP: Bilevel positive airway pressure that delivers air with different pressures for inhalation and exhalation.
What are the indications for mechanical ventilation?
The indications for starting mechanical ventilation in a patient are
- Abnormally slow breathing (bradypnea)
- Cessation of breathing (apnea)
- Abnormally rapid breathing (tachypnea)
- Inefficient exchange of gases
- Respiratory muscle fatigue
Who needs mechanical ventilation?
Mechanical ventilation is a life-support treatment in the hospitals for critically ill people in acute respiratory distress or failure. Ventilation may be required by patients in conditions that include:
- Short-term ventilation while being under general anesthesia for a surgical procedure.
- Severe heart disease
- Acute lung injury
- Hypotension
- Coma
- Sepsis and multiorgan failure
- Neuromuscular diseases
- Pneumonia
- Acute asthma
- Chronic obstructive pulmonary disease (COPD)
- Acute respiratory distress syndrome (ARDS)
- Bacterial inflammation in the lungs
- Viral infections in the respiratory system such as
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What are the risks and complications of mechanical ventilation?
Mechanical ventilation has a few risks and complications that can sometimes be life-threatening. The complications can arise during intubation or with ventilation.
Complications of intubation
- Upper airway and nasal trauma
- Tooth displacement (avulsion)
- Injury to the mouth, throat, vocal cords or trachea
Prolonged intubation might cause:
- sinusitis
- tracheal narrowing (stenosis) or tissue death (necrosis)
- edema in the vocal cords
- infection in the respiratory system
- pneumonia
- sepsis in the bloodstream
Complications of ventilation
- Ventilator-induced lung injury leading to alveoli rupture and lung collapse (pneumothorax) from:
- Barotrauma – trauma caused by excess air pressure
- Volutrauma — caused by excess volume of air
- Oxygen toxicity from too much oxygen
- Ventilator-assisted pneumonia caused by bacterial and viral infections in the lung
- Medication side effects and reactions
- Effects on other organs such as
- blood circulation
- heart
- kidneys
- abdomen
- Ventilator malfunction
- Inability to wean off from the ventilator
- Sepsis
- Death