Ventilators: How They Work And Why They're No Panacea For Coronavirus Patients : Short Wave During the pandemic, ventilators have been considered a vital medical tool to treat critically-ill COVID-19 patients. But more and more evidence is suggesting that those who go on a ventilator — don't end up surviving. NPR Science Desk correspondent Jon Hamilton tells us about how these machines work, and how, for patients who do survive, recovery can be a long road.
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The Hard Truth About Ventilators

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The Hard Truth About Ventilators

The Hard Truth About Ventilators

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MADDIE SOFIA, HOST:

You're listening to SHORT WAVE from NPR. We've been hearing a lot about how important ventilators are during this pandemic, especially when it comes to treating the most critically ill COVID-19 patients. So we're taking a closer look with NPR science correspondent Jon Hamilton. Hi, Jon.

JON HAMILTON, BYLINE: Hi. How's it going?

SOFIA: Good. Good to talk to you. Good to hear your voice. OK. So, Jon, you've been reporting on what happens when COVID-19 patients actually end up going on ventilators.

HAMILTON: That is right. And I want to start by introducing you to someone who actually came off a ventilator. This is a guy named David Williams. He's a Marine Corps veteran, and he nearly died of COVID-19, and he finally got out of the hospital a few weeks ago.

(CHEERING)

HAMILTON: So that sound you're hearing, that is the sound of the hospital staff cheering David as he left the door.

SOFIA: That's awesome. That's nice.

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UNIDENTIFIED PERSON: Don't come back now, ya hear?

SOFIA: So how long was he on a ventilator?

HAMILTON: For about a week - eight days I think. And now that he's at home, he is facing a lot of rehabilitation. I spoke with him just a few days ago, and he was still hooked up to an oxygen machine.

DAVID WILLIAMS: I just wear my oxygen. I have, like, a hundred-foot cord. And so I'll wear my oxygen in my nose and I'm still able to travel all over the house.

HAMILTON: Yeah. And he was also still depending on a walker to get around sometimes.

WILLIAMS: So I need it when I have to wake up in the middle of the night or something to go to the bathroom because, you know, trying to get the feet going again is a little rough.

SOFIA: So he's not on a ventilator anymore, Jon, but it sounds like David's still struggling quite a bit.

HAMILTON: Yeah, Maddie, he's still got a ways to go. But, you know, as as hard as David's recovery has been, he is definitely one of the lucky ones. I mean, he's alive. There is more and more evidence now suggesting that most COVID patients who go on a ventilator, they don't end up surviving. And for people who do survive, people like David, the road to recovery can be pretty rocky.

SOFIA: So today on the show - the hard truth about ventilators, how these critically important devices come with a cost. I'm Maddie Sofia, and this is SHORT WAVE, the daily science podcast from NPR.

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SOFIA: OK, Jon, so ventilators are machines that basically help a patient breathe when their lungs can no longer deliver enough oxygen to keep the body going, right?

HAMILTON: Right, Maddie. I mean, sometimes, they just help a person breathe. Sometimes they pretty much take over all of the effort of breathing. I actually talked with Dr. Tiffany Osborn about how ventilators work. She's a critical care specialist at Washington University in St. Louis. And she's been taking care of COVID-19 patients at Barnes-Jewish Hospital there. She told me that putting a patient on a breathing machine is a pretty extreme measure.

TIFFANY OSBORN: We give sedation so that the person goes to sleep, and then we provide a paralytic that stops their breathing.

HAMILTON: Next, they intubate you. That's where they insert this long plastic tube through the trachea and the vocal cords. And that allows a machine to send these puffs of highly oxygenated air to your lungs.

SOFIA: So it's not like an oxygen mask. It's actually a tube in your throat directly delivering air to your lungs.

HAMILTON: Right.

SOFIA: And so I have to imagine that can be, like, pretty tough on your body, right?

HAMILTON: Yeah, it can be. I mean, here's what Osborn says.

OSBORN: The ventilator itself can do damage to the lung tissue based on how much pressure is required to help oxygen get processed by the lungs.

HAMILTON: And she says COVID-19 patients often need these dangerously high levels of both pressure and oxygen because the virus causes so much inflammation in their lungs.

SOFIA: So how effective are these ventilators, Jon?

HAMILTON: Unfortunately, not as effective as we'd like. Doctors in China and the U.K., the U.S., they're all reporting death rates that range from over 50% to more than 80% And here's what Osborn says.

OSBORN: We're not sure how much help ventilators are going to be. They may help keep somebody alive in the short term. We're not sure if it's going to help keep someone alive in the long term. It's very concerning to see how many patients who require ventilation do not make it out of the hospital, how many of them die.

HAMILTON: So this is all early research, but it's kind of disturbing.

SOFIA: Yeah. Wow. So why is that? Why do we think so many patients on ventilators die?

HAMILTON: Not one answer. Ventilators can work really well for patients who have these common forms of pneumonia, but the coronavirus, often it does a lot more lung damage than, say, the flu. And in some patients, the damage is so bad that even ventilation doesn't seem to help. And also the longer patients remain on a breathing machine, the more likely they are to die.

SOFIA: Is that because people with the most severe cases tend to be on ventilators the longest or that being on a ventilator messes up the lungs more?

HAMILTON: It's both of those. Also there's this big risk from being on a ventilator which is that the tube carrying air and oxygen to the lungs provides this pathway for dangerous germs. So many ventilated patients get a new lung infection, a problem that's called ventilator-associated pneumonia.

SOFIA: Right, right, because, like, normally the air you breathe gets filtered through your nose. And there's physical barriers like hairs and mucus, and your immune system has a chance to grab some of those germs on the way in. But in this case, you're introducing air directly into your lungs.

HAMILTON: Exactly.

SOFIA: OK. OK. So let's talk about those who do survive and what their recovery looks like.

HAMILTON: Yeah. Well, I talked to Dr. Amy Bellinghausen at the University of California San Diego. And she told me that some COVID-19 survivors will never recover completely.

AMY BELLINGHAUSEN: Unfortunately, oftentimes when they're coming off the ventilator, it's not the same person as who went on the ventilator.

HAMILTON: They have this condition that's called post-ICU syndrome, and it can produce these long-term disabilities. Bellinghausen says most patients start out, like, so weak that they are nearly helpless.

SOFIA: Wow.

BELLINGHAUSEN: That whole time in the ICU, they're losing muscle mass. People lose 20, 30, 40 pounds over a week or two in the ICU.

HAMILTON: And she says on top of that, you have a lot of patients who have organ damage.

BELLINGHAUSEN: People can have injuries to their lungs or scarring in their lungs. Sometimes kidneys are impacted. But really any organ can suffer injury in the ICU.

HAMILTON: Yeah, even the brain. Bellinghausen says one reason is the kind of drugs they use to keep patients sedated while they're on a ventilator.

BELLINGHAUSEN: The other thing is that patients who have bad lung disease often have times when their oxygen level is very low. And that also causes damage to the brain.

SOFIA: And, Jon, I mean, after having trouble breathing and then being sedated with a tube down your throat, I have to imagine there's got to be an emotional impact, too, right? Like, I'm sure I would be really freaked out by this process.

HAMILTON: Yeah, anybody would be. Absolutely. I mean, you're talking about patients who already may be delirious from fever or from sedatives. Then they find themselves - they're, you know, trapped in this scary, noisy place, and they're connected to machines that have taken control over pretty much all of their bodily functions. And then if someone resists, they may actually be forcibly restrained for their own protection. And Bellinghausen says all of those things together can make someone kind of paranoid.

BELLINGHAUSEN: They really think that all these efforts that we're doing in the ICU to try to save their life may be trying to harm them. And so people come out of the ICU with pretty profound symptoms of PTSD sometimes, or post-traumatic stress disorder.

SOFIA: Wow, Jon, this is - I mean, this is awful. I had no idea about this. This sounds really tough, both for the patient and for, like, the medical professionals.

HAMILTON: Yeah. Some doctors told me that it's - for the patient, it can be like being in combat or being the victim of a violent assault. But Bellinghausen says there are some COVID-19 survivors who make it through all of this and do recover over time. So remember David Williams, the marine we heard from earlier.

SOFIA: Yeah, yeah.

HAMILTON: He told me when he was first waking up and they were getting ready to take him off the ventilator, he had almost no control of his arms or legs. And he was really thirsty all the time.

SOFIA: And being thirsty, that's a pretty common, you know, symptom for patients that are on a ventilator, right?

HAMILTON: Yeah, it is. Your mouth gets really parched. You've got this tube in there. And for David, he couldn't drink yet because he still had the tube down his throat. So this nurse gave him this damp swab that he was supposed to suck on.

WILLIAMS: It took me, like, five or six minutes just to pick that thing up, to get my fingers actually on it and my brain telling my hand to lift it up and, you know, to put it in my mouth.

HAMILTON: David is a lot better now. He can feed himself. He can type. He can do most things, but he's still having problems with his memory and with thinking. I mean, he's struggling with things like remembering computer passwords and sometimes even finishing sentences.

SOFIA: Wow.

WILLIAMS: It was hard for me to try and recall things or - 'cause, like, right now, it takes me a while to think about the words I need to be able to say now. But I'm slowly getting it back.

HAMILTON: Yeah. So, you know, as he's recovering, David is having to figure out ways to sort of work around his limitations. You know, that said, he started the process of going back to his job as veteran service coordinator at the University of Central Arkansas.

SOFIA: Wow. This is - I mean, this is a lot, Jon. I remember when I first heard your reporting on this, I think it kind of shook me because there's been so much focus on availability of these ventilators, and it just felt like if we could get enough of them to the right places, people would be OK.

HAMILTON: Yeah. That kind of was the thinking. And, you know, to be fair, ventilators are really important. They can save lives. You know, David Williams probably wouldn't be around anymore if he hadn't been on one. But what I've learned is that they're not a panacea.

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HAMILTON: For some people, this virus is so profoundly damaging to the body that even the most advanced medical technology isn't enough. And when it does save someone, they may have to deal with long-term damage, not only from the virus but also from the technology that kept them alive.

SOFIA: OK, Jon, thank you so much for sharing this reporting with us. It is super difficult to hear but important to know. I appreciate you.

HAMILTON: Thanks, Maddie.

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SOFIA: This episode was produced by Brit Hanson, edited by Viet Le and fact-checked by Emily Vaughn. I'm Maddie Sofia. Thanks for listening to SHORT WAVE from NPR.

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