COVID-19 Resources

Severe COVID-19 Symptoms: How Ventilators Can Help

Jun. 8, 2020

In the early days of the COVID-19 outbreak, as the rate of positive cases started to increase, and healthcare systems began learning and preparing for a surge of patients, mechanical ventilators, among other medical supplies like personal protective equipment (PPE) and hand sanitizer, were deemed essential to patient care as everyone braced for the unknown.

COVID-19 Ventilator

Today, we know that COVID-19 most commonly begins with mild respiratory symptoms, including cough, fever and shortness of breath. For most, that’s where it ends. For others, however, COVID-19 can cause severe hypoxemia, a condition that alters the lungs’ ability to transfer oxygen into the arterial blood, resulting in severe shortness of breath.

When oxygen levels become low (oxygen saturation < 85%), patients are usually intubated and placed on mechanical ventilation. For those patients, ventilators can be the difference between life and death.

“The decision to place a patient on a ventilator is usually made by observing the patients’ response to treatment and measuring the oxygen and carbon dioxide in the blood,” said Richard Branson, MS, RRT, UC Health registered respiratory therapist and professor in the Department of Surgery at the University of Cincinnati College of Medicine.

“Some patients become tired and show use of accessory muscles in the neck to try and breathe. This is a sign of increased work of breathing,” Branson continued. “When this is seen, in combination with a fall in oxygen saturation, a rise in arterial carbon dioxide and a fall in blood pH, intubation and ventilation is indicated.”

What is a ventilator?

A ventilator is a complex microprocessor device that helps keep your lungs working. This breathing machine can provide the required volume, pressure and flow to normalize oxygen, carbon dioxide and pH levels in the blood. It monitors and responds to the unique needs of each patient.

While a ventilator cannot treat or fix a health problem from a disease such as COVID-19, it can do the breathing work that your lungs are not able to do while you are being treated or recovering from an illness or health condition.

“Mechanical ventilation is a life-support treatment,” said Branson. “It does not ‘cure’ a disease, it simply provides support while other treatments, like antibiotics, surgery or antiviral medication work.”

Branson goes on to explain, “You can deliver mechanical ventilation a few different ways. You can use a mask, which is a standard of care for COVID-19 patients or an endotracheal tube (intubation) that is placed through the vocal cords and into the trachea.”

Importance of Ventilators and the Teams that Make Using Them Possible

In the wake of COVID-19, mechanical ventilation has been a consistent topic of conversation. However, there are other instances in which a ventilator may be required for patient care.

Ventilators can be used short-term after surgery. They are used in the intensive care unit (ICU) when patients have pneumonia, sepsis or have experienced major trauma. Patients with neuromuscular diseases, such as amyotrophic lateral sclerosis (ALS) and spinal muscular atrophies (SMA), among others, routinely require long-term mechanical ventilation.

Mechanical ventilation, like any medical intervention, does not come without risks. Complications, including damage to the lung from excessive pressure or volume, a decrease in cardiac function from the positive pressure in the chest, or lung rupture, although rare, can occur.

Some patients require sedation to tolerate ventilation, which can increase their time in the ICU and contribute to delirium or hallucinations. The presence of an endotracheal tube placed through the mouth and into the windpipe can lead to an increased risk of infection.

To help reduce potential complications, the use of a ventilator requires special training and the expertise of a critical care team – an intensivist, a critical care nurse, critical care respiratory therapist and a critical care pharmacist. At UC Health, this multidisciplinary team plays a crucial role. Each subspecialist works together to program, monitor and adjust each ventilator to ensure the best outcome based on the individual care plans determined for their patients.

“Because of the number of highly-trained physicians and the ongoing experience they gain caring for the sickest patients, UC Health has been a leader in the Cincinnati area for critically-ill patients of all causes,” says Evan Ramser, DO, UC Health pulmonary disease physician and assistant professor in the Department of Internal Medicine at the UC College of Medicine. “When special circumstances such as the COVID-19 pandemic sweep over the region, we are uniquely positioned to care for these patients.”

The safety of our critical care teams and clinical staff remains equally as important as the safety of our patients.

“This is unprecedented and worrisome. The disease is easily spread and indiscriminately lethal,” Branson said. “Social distancing has been crucial for limiting the spread of disease and preventing a surge of patients which would strain hospital resources.”

UC Health has implemented strict procedures for donning and doffing, or putting on and taking off PPE, which is critical for everyone’s safety. Our staff is diligent about wearing the proper N95 masks and PPE - face shield, gloves and gown - when entering patient rooms.

The Power of Academic Medicine

Research and clinical trials have also played a critical role in the safety of our staff and the care we offer to our patients. As the region’s academic health system, our physician researchers are leading the way through scientific discovery and our dedication to finding a cure for this disease.

Researchers at UC Health and the UC College of Medicine are working around the clock to explore new treatments and begin clinical trials to test new therapies for COVID-19.

“We had the advantage of seeing the impact of COVID-19 in New York and other coastal cities. The planning, canceling of surgeries, use of PPE and protocols for managing patients with an infectious respiratory illness were critical,” Branson said. “Now, UC is involved in a number of clinical trials to find best treatments for the disease.”

Branson continued on to explain, “We have evaluated the application of treatments like prone positioning to improve blood oxygen and the use of monitoring techniques to optimize how to program ventilator settings. We have also been studying the ability of the ventilator to use artificial intelligence to automatically change settings to meet patient needs. This could be very important in a situation like COVID 19 where we are trying to limit trips into the patient’s room.”

The COVID-19 pandemic has affected all of our lives, bringing our community together through research and innovation. This is made evident by those joining the fight, like Jennifer Raaf, a UC physics graduate and a particle physicist at the Fermi National Accelerator Laboratory in Illinois. She is currently helping to meet a global ventilator shortage in the wake of COVID-19.

Jennifer is part of an international team of scientists and engineers who won federal regulatory approvals for a simple ventilator that could be produced quickly with common parts.

Ventilators, among other things, have been crucial as we navigate this pandemic. We are here to keep those around us safe and healthy as our knowledge grows and changes with each passing day. In times of crisis, we are proud to be a source of hope for our patients and our community.