For weeks, we’ve been hearing that the lack of ventilators is a huge part of the COVID-19 crisis — if only we had enough of them. But when SurvivorNet spoke with Dr. James N. Dillard, clinical professor at Columbia University College of Physicians and Surgeons, he expressed deep concern about the misleading messages we’re getting about ventilators in many media reports.Read More
“I am not seeing the reality of ventilators being told to the American people,” says Dr. Dillard, who has private practices in Manhattan and East Hampton, NY. “I’m a seasoned senior physician who has been teaching medicine for most of my life. It’s frustrating to see senior ER physicians and critical-care doctors interviewed on the news and, at no point, does anyone stop and say: ‘Let’s get real about ventilators.'”
Cancer Survivors Have A Deeper Understanding
This is where the cancer community can play an important role in this crisis, Dr. Dillard insists. “A lot of people with cancer have had surgeries — they know what it’s like to have an endotracheal tube. And because they understand what non-survivors don’t, they can raise awareness about how crucial it is to remain under quarantine during this crisis.”
‘Ventilators are being thought of as magic machines,” he continues. “But a ventilator is not a Fitbit you can strap onto your wrist. It’s not an app you install on your phone. Being on a ventilator is the most uncomfortable thing you can possibly imagine. As doctors, we’ve seen it. We know how awful it is to be tubed.”
What Happens When You’re Put on a Ventilator
While some cases can be managed at home, when a patient with COVID-19 lands in the hospital, it’s often due to swelling and fluid in lung tissue, which causes difficulty breathing. “In COVID-19 patients, all of the potential spaces between the bronchi, the intercellular spaces, are full of interstitial edema. And that’s why the lungs can’t do the work. You can’t suck air into waterlogged lungs,” he explains, “you suffocate.”
At this point, a ventilator may become necessary to help patients who are struggling to breathe on their own.
“It’s not a simple procedure to put a patient on a ventilator. It requires a team of 3 people minimum, often 4 or 5,” says Dr. Dillard. “You have a whole checklist you have to go through beforehand, like a pilot before takeoff, in order to start an intubation.”
And to reach that point you, the patient, have to be suffocating, he says.
“Before they start, you’ll have to be sedated. Then, to begin the procedure, you have to be temporarily paralyzed. They’ll squeeze air into your lungs through a hand-held bag on a mask to get your oxygen levels up before the doctor puts the tube down your throat. Doctors often miss the first time, when they go to intubate. You can have vocal chord damage, among other things.”
“After the procedure, as you wake up, the first thing you’ll want to do is reach up to pull the tube out with your hands,” Dr. Dillard notes. “To prevent this, you’ll find that your wrists have been shackled to the bed.”
Secretions and Suction
Once a patient in on a ventilator, it takes a team of medical specialists to manage their condition and keep their lungs clear. “As the ventilator pushes air down into the lungs to take over the work of breathing, it takes doctors, nurses, and respiratory therapists – who are the real experts– to manage the patient and the pressure settings. If the airflow is too high, it can block the return of blood to the heart or even blow up the lungs,” Dr. Dillard explains. Too much airflow can also block the return of blood flow to the heart and trigger a stroke or heart attack.
Even under ideal conditions, “they then have to suction the secretions out of your lungs. If your lungs are full of secretions, you’ll get pneumonia and die. And if the ventilator is pushing air into an obstructed lung that’s full of interstitial fluid, which is what we hear described as ‘ground-glass opacities,’ you’ll force the mucous even deeper into the lungs. You can’t push air through a mucous plug. So they’ll use percussive hammers to loosen the mucous so they can suction it.”
What Are The Odds?
And then there are the numbers: “The majority of people do not live after they’re put on a ventilator,” Dr. Dillard says. “The numbers are around 20 to 25 percent of people coming off of ventilators. Most do not. Some figures are as high as 45 percent, but none of these are break-even odds,” he says.
While the scramble to increase the supply of ventilators to hospitals continues, Dr. Dillard, like all medical professionals, says our best defense against COVID-19 is to continue social-distancing, hand washing, and now — according to new guidelines — wearing masks in public places.
This is where the cancer community can help, he says. “In their day-to-day lives, cancer patients hear people talk about illness and health issues in a way that can sound really trivial. They have a deeper understanding of what’s involved. So they can play an important role in informing the non-cancer community that ventilators are not a simple fix — the best advice now is to stay home.”