Ventilator

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Ventilator

The coro­n­avirus epi­dem­ic has opened up new med­ical terms for peo­ple. Many of us have heard that the treat­ment of pneu­mo­nia requires a ven­ti­la­tor that sup­ports breath­ing. Maybe it’s worth buy­ing for use at home?
Ventilator
IVL device.

Pan­dem­ic COVID-19, which was pro­voked by a new, pre­vi­ous­ly unknown coro­n­avirus with the tricky sci­en­tif­ic name SARS-CoV­‑2, taught us to wash our hands and keep a dis­tance of about 1.5 — 2 meters from each oth­er. In addi­tion, we learned that the infec­tion pre­dom­i­nant­ly affects the res­pi­ra­to­ry tract. More­over, the low­er res­pi­ra­to­ry tract pre­dom­i­nant­ly suf­fers — small bronchi and lung tis­sue.

The most dan­ger­ous man­i­fes­ta­tion is pneu­mo­nia — inflam­ma­tion of the lungs caused by a virus. Due to inflam­ma­tion, tis­sue ede­ma, the exchange of gas­es between the blood and the pul­monary alve­oli (sacs filled with air and braid­ed with small cap­il­lar­ies) is dis­rupt­ed. In the alve­o­lus, car­bon diox­ide is removed from the blood, which is exhaled into the exter­nal envi­ron­ment, and at the same time oxy­gen enters the blood, which is nec­es­sary for all cells of the body for metab­o­lism.

Oxy­gen defi­cien­cy due to dys­func­tion of the affect­ed, inflamed lungs pro­vokes the devel­op­ment of res­pi­ra­to­ry fail­ure, hypox­ia (lack of oxy­gen) and meta­bol­ic dis­or­ders, seri­ous mal­func­tions in the body.

In some cas­es, if the inflam­ma­tion is severe and exten­sive, affect­ing a large vol­ume of the lungs, it may be nec­es­sary to use mechan­i­cal ven­ti­la­tion (ven­ti­la­tion of the lungs) or, in espe­cial­ly severe cas­es, ECMO (extra­cor­po­re­al mem­brane oxy­gena­tion pro­ce­dure).

With the devel­op­ment of pneu­mo­nia (SARS caused by coro­n­avirus), some patients, and those, accord­ing to sta­tis­tics, from 10 to 15% of all hos­pi­tal­ized patients, can be trans­ferred to a ven­ti­la­tor. Due to mod­ern tech­nol­o­gy, the nec­es­sary oxy­gen sat­u­ra­tion of the blood is main­tained so that the body can ful­ly work, main­tain its vital activ­i­ty, while the immune sys­tem grad­u­al­ly copes with the virus.

Pneu­mo­nia

Every­one can catch pneu­mo­nia, but for some it is espe­cial­ly dan­ger­ous.

What is a ventilator for?

Not all peo­ple need arti­fi­cial ven­ti­la­tion, only when a large vol­ume of lungs is affect­ed, severe inflam­ma­tion, when the body itself sim­ply can­not cope with the func­tion of gas exchange — sat­u­rat­ing the blood with oxy­gen and remov­ing car­bon diox­ide. The prob­lem is that dur­ing the inflam­ma­to­ry process, the alve­oli swell, grad­u­al­ly fill with liq­uid, which makes gas exchange impos­si­ble. In this case, the res­pi­ra­to­ry func­tion is par­tial­ly or com­plete­ly tak­en over by the ven­ti­la­tor.

High mor­tal­i­ty in some coun­tries affect­ed by the epi­dem­ic, in par­tic­u­lar in Italy and Spain, is due to the fact that all seri­ous­ly ill patients sim­ply do not have enough ven­ti­la­tors and they die from res­pi­ra­to­ry fail­ure, sud­den meta­bol­ic fail­ures against the back­ground of hypox­ia.

Hypox­ia is espe­cial­ly dif­fi­cult for the elder­ly, patients with chron­ic dis­eases — heart, lung, dia­betes or can­cer. It is they who are at par­tic­u­lar risk and the main can­di­dates for mechan­i­cal ven­ti­la­tion.

Those peo­ple who have a mild infec­tion cope with res­pi­ra­to­ry dis­or­ders with­out much dif­fi­cul­ty, they have a small part of the lungs affect­ed or no pneu­mo­nia at all.

In a state of mod­er­ate sever­i­ty, oxy­gen ther­a­py can be indi­cat­ed — the use of a mask or nasal catheter, through which a gas mix­ture with an increased lev­el of oxy­gen is sup­plied. If this is not enough and the lev­el of blood oxy­gen sat­u­ra­tion decreas­es, the ques­tion of trans­fer­ring to a ven­ti­la­tor is accept­ed, which requires expe­ri­enced per­son­nel who con­nects to the device and mon­i­tors the con­di­tion.

Human lungs

How our lungs are arranged and how to under­stand when they are not all right

How the ventilator works

Explain­ing in sim­ple terms how the ven­ti­la­tor works, we empha­size that this is a com­plex device that is used in con­junc­tion with oth­er equip­ment, a lot of nec­es­sary con­sum­ables, and aux­il­iary manip­u­la­tions. It forcibly deliv­ers a gas mix­ture (oxy­gen with air) to the lungs and removes the released car­bon diox­ide. There are sev­er­al options for con­nect­ing to the device: in milder cas­es, it can be a face mask con­nect­ed to the hand­set and the device. A gas mix­ture of a strict­ly spec­i­fied tem­per­a­ture, humid­i­ty and pres­sure is sup­plied through it.

As res­pi­ra­to­ry fail­ure increas­es or in cas­es where the res­pi­ra­to­ry mus­cles can­not work effec­tive­ly, an endo­tra­cheal tube is placed in the patient, through which the gas mix­ture is fed direct­ly into the bronchi and lungs.

When pro­vid­ing emer­gency care, if it is an ambu­lance deliv­er­ing a patient to a hos­pi­tal, or a hos­pi­tal emer­gency depart­ment where a severe patient is admit­ted, a man­u­al ven­ti­la­tor (or an Ambu bag) can be used. Due to it, doc­tors can main­tain breath­ing until the patient is already trans­ferred to the device (or in emer­gency sit­u­a­tions — for exam­ple, turn­ing off the light).

IVL in the hospital

The ven­ti­la­tor itself will not help the patient unless there is an expe­ri­enced physi­cian and nurs­ing staff trained to work with this com­plex tech­nique. In addi­tion, often in the treat­ment of severe patients and the pro­vi­sion of resus­ci­ta­tion, oth­er devices, appa­ra­tus and equip­ment, med­i­cines and devices (venous catheters, laryn­go­scopes, infu­sion pumps, car­diac mon­i­tors, pulse oxime­ters, etc.) are also need­ed. Actu­al­ly, doc­tors have a con­cept of an inten­sive care bed — this is not only the func­tion­al bed itself, but also all the equip­ment nec­es­sary to help a seri­ous­ly ill patient, as well as the staff who work with the patient — nurs­es and doc­tors.

It’s impor­tant to know!

The best masks to pro­tect against virus­es: learn­ing to choose

IVL at home

Although today the Inter­net is full of ads for the sale and pur­chase of a ven­ti­la­tor for the home, you should not believe and try to pur­chase these devices. It is impos­si­ble to treat seri­ous­ly ill patients at home — this means know­ing­ly doom­ing them to death, since a ven­ti­la­tor alone is not enough, and equip­ping an inten­sive care bed in your apart­ment is unre­al­is­tic even for a lot of mon­ey.

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Portable ven­ti­la­tors are in ambu­lances (and even then not all) and they are need­ed to tem­porar­i­ly trans­fer the patient to arti­fi­cial ven­ti­la­tion in order to sup­port the patient until he is hand­ed over to the hos­pi­tal doc­tors.

How much and where to buy a ventilator

But do not be puz­zled by the ques­tion — where to buy a ven­ti­la­tor. Con­sci­en­tious sup­pli­ers work only with legal enti­ties, pub­lic pro­cure­ment and direct­ly with clin­ics. And if this is a “black mar­ket” of equip­ment, there is a chance of run­ning into scam­mers who, under the guise of a ven­ti­la­tor, will sell com­plete­ly dif­fer­ent devices that will not help save a person’s life.

Popular questions and answers

We asked ques­tions about IVL pathol­o­gist, junior researcher, Nation­al Research Cen­ter for Pedi­atric Hema­tol­ogy, Oncol­o­gy and Immunol­o­gy named after N.N. Dmit­ry Rogachev Dmit­ry Abramov.

Do you need a ventilator at home? Is it possible to purchase a ventilator to treat a person at home?

- No, by no means, it is very dan­ger­ous for him and those around him — Dmit­ry Abramov is sure. — First­ly, if it is COVID-19, the patient is con­ta­gious and all those around, being con­tacts, are at risk of con­tract­ing a coro­n­avirus infec­tion. They should all be mon­i­tored, and a per­son with a con­firmed virus and in a mod­er­ate to severe con­di­tion, which requires oxy­gen ther­a­py, the use of drugs or a trans­fer to a ven­ti­la­tor, should be treat­ed only in a hos­pi­tal. As the expe­ri­ence of col­leagues from oth­er coun­tries, as well as the data of our clin­ics, showed, the con­di­tion can wors­en in just a few hours. If there are no doc­tors near­by, it threat­ens death.

Can an inexperienced person use a portable ventilator?

- In no case! Only expe­ri­enced resus­ci­ta­tors and infec­tious dis­ease spe­cial­ists who have under­gone spe­cial train­ing should work with ven­ti­la­tors and man­age patients with COVID-19. In inex­pe­ri­enced hands, a ven­ti­la­tor can become use­less at best and dan­ger­ous to health at worst. Even if it is a resus­ci­ta­tor, he does not have the right by law to pro­vide such assis­tance at home, for any doc­tor who vio­lates these rules, crim­i­nal lia­bil­i­ty is pos­si­ble. Out­side the con­di­tions of resus­ci­ta­tion, even the most expe­ri­enced doc­tor will not cope. And again, remem­ber that this is a patient infect­ed with COVID-19, which means that he is con­ta­gious and dan­ger­ous for the doc­tor him­self. To work with it, you need iso­lat­ed box­es, over­alls and room treat­ment. There­fore, it can­not be treat­ed at home unam­bigu­ous­ly.

Can artificial ventilation harm?

- Nat­u­ral­ly, like any com­plex manip­u­la­tion and inva­sive treat­ment, mechan­i­cal ven­ti­la­tion can have cer­tain com­pli­ca­tions. If this is an expe­ri­enced resus­ci­ta­tor who strict­ly mon­i­tors all aspects of lung func­tion and mon­i­tors per­for­mance, prob­lems are extreme­ly rare. But they are not exclud­ed. This may include sec­ondary con­ges­tive pneu­mo­nia, already of a micro­bial nature, or aspi­ra­tion pneu­mo­nia, if face masks are used for more than a day.

If the mode of gas sup­ply is incor­rect­ly select­ed, aci­do­sis (acid­i­fi­ca­tion of the blood) or alka­lo­sis (alka­lin­iza­tion) is pos­si­ble in almost all patients. These process­es are dan­ger­ous for metab­o­lism and must be cor­rect­ed imme­di­ate­ly. Pro­longed mechan­i­cal ven­ti­la­tion for more than 2–3 weeks is dan­ger­ous for the devel­op­ment of patho­log­i­cal changes in many organs, includ­ing the lungs and bronchi them­selves.

Anoth­er seri­ous com­pli­ca­tion is baro­trau­ma, dam­age due to incor­rect­ly select­ed pres­sure of the gas mix­ture. It is espe­cial­ly dan­ger­ous for thin and weak­ened patients, chil­dren.

And all these facts once again give an answer to your ques­tion — do you need a ven­ti­la­tor at home. I want to urge patients once again: at the first sign of infec­tion, con­sult a doc­tor!

By Yraa

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