"ventilation is brutal" - what does this mean?

[ellanwood]

I saw this on another thread and didn't want to derail it by asking. Also a news report said something similar. I just don't understand what this means or how it is brutal. I thought it was just oxygen.

[MozzchopsThirty]

@kevintheorangecarrot. I think it's been established in the daily mail 🤔

Not by any actual intensivists

[cosmo30]

I had surgery and also remember something being pulled from my throat when I came round. It was weird and my throat hurt after !!

[mykingdom]

@kevintheorangecarrot Nothing has quite been established.

[MichaelBoobins]

My mum was on a ventilator before she died and it just forced her chest up and down so mechanically and that’s the one thing that’s really stayed with me about her death. It was not nice to see

[kevintheorangecarrot]

It's already been established that ventilators do not work for covid patients. But it is a new virus and nobody knows how to deal with it unfortunately.

[CaroleFuckinBaskin]

Thank you for the explanation @mykingdom It was semi-urgent surgery with other issues going on so I didn't think much of it at the time!

[wheresmymojo]

Sorry I thought I was being clear that it's a 50% chance of waking up in terms of the current pandemic.

Not ventilation irrespective of cause.

[mykingdom]

@wheresmymojo mechanical ventilation isn't usually such bad odds and is usually a sophisticated lifesaver ('life support' in everyday terminology). Coronavirus patients who reach the threshold for it are already very ill irrespective of this intervention. Let's not frighten people.

[TheyDressedMeUpLikeThis]

My father refused ICU and ventilation when he was dying due to its invasive nature. He wanted only the 'good drugs' and to be allowed to die. He was terminal though.

My mother is now elderly but still my mother and has done the same. She has a detailed advance care directive and woe betide the person who attempts to treat her! I would not dare.

I have not personally witnessed ventilation though I studied cases concerning it as part of health law.

I think in my circumstances (43, fit and healthy) it would be something I would be willing to try. But I suspect that will change as time goes on. I do not yet have an ACD but I am starting to think about it, so my family don't have to.

Sometimes the treatment is "worse" than the disease.

[wheresmymojo]

Plus I would add it is psychologically difficult.

It is anyway...but at the moment people know they only have a 50% chance of waking back up again and so are saying goodbye to loved ones before they're sedated

[mykingdom]

@CaroleFuckinBaskin Yes, a general anaesthetic for surgery means you have an anaesthetist looking after you on a ventilator while the surgeon gets on with the procedure. Once you go to the theatre recovery area, the endotracheal tube is removed and a normal mask is popped on to help you while you 'come round' a bit more ready for transfer to the post op ward. You have to be awake for extubation and there is always a period of time while you breathe through this tube independently without being attached to a ventilator post op so some people do remember this.

[CaroleFuckinBaskin]

If you have a general anaesthetic for a surgical procedure, you are intubated and on a ventilator for the duration of the surgery and then the breathing tube is removed in the recovery area and a normal oxygen mask. Most people don't remember any of this.

Interesting... Reading this thread I was just wondering about when I had surgery under a GA a couple of years ago. As I came round I felt like they were pulling something out of my throat and it was a bit uncomfortable? So I was intubated then, proper tube down the throat stuff? I never really thought to ask at the time! So they pull it out just as you are coming round and start breathing on your own again?

[meow1989]

Theres different types of invasive (with a tube in your trachea through your nose or mouth) ventilation: CPAP where the person is breathing themselves but the ventilator maintains a pressure so that the lungs arent able to deflate fully, making it easier to take an in breath;
BIPAP where the ventilator breaths for the patient by forcing air into the lungs then letting them deflate (not comlletely) then repeating;
And oscillation, where the ventilator keeps the lungs open and "vibrate" them at a fast rate rather than take proper breaths.

In addition to ventilation itself, if you are being ventilated you probably have: sedation (the "induced coma") possibly drugs paralyzing you, a central line to give IV drugs, an arterial line to monitor blood pressure (and blood thinning infusion to keep it patent), a nasogastric tube, a catheter, depending on the reason for intubation you might have a drain.

With the ventilation runs the risk of further chest infection (ventilator acquired pneumonia), muscle wastage and pressure ulcers amongst other things.

Ventilating a patient is not a decision taken lightly. However it is life saving treatment and the medical staff do amazing things to keep people alive every day. For kids at least ventilation is normally pretty short term (days rather than weeks) on average. I would take ventilation if I needed it without a second thought assuming I was likely to survive whatever landed me in ICU. I would not have supported it for my elderly nan before she died.

Theres lots of medical procedures that are frightening of you look at the specifics of what's involved in fairness.

[okiedokieme]

Ventilation can save lives but what drs are trying to say is that it isn't a miracle cure, it has side effects and you need to be strong enough to be able to tolerate it - in particular it may not be appropriate for those with lots of comorbidities especially advanced in age. Once on a vent it can be hard to get people off and it's a hard decision to turn it off. A horrible choice to have to make, not cut and dry for sure

[mykingdom]

@CocoCorona Yes, when you have a general anaesthetic, a ventilator will take over your breathing until your anaesthetic wears off and you can breathe unaided again.

[JackJackIncredible]

@mykingdom

It’s ok, I can see you were trying to be reassuring. :) it’s a scary time for people, many unknowns.

[mykingdom]

@JackJackIncredible I'm sorry too, I was being rather dismissive of the fear and trauma associated with being an intensive care patient. It wasn't my intention. It's a very scary place to be both physically and mentally.

[TwittleBee]

I wondered what it was like to be Ventilated when I've seen my babies on Ventilators. Their nurses always said they're comfortable and it isnt painful for them but my 3rd son pulled it out himself so it must feel uncomfortable for a preemie to do that?

[LilacTree1]

Well OP I haven’t much to add

Except I wouldn’t want it again and have put a sign on the inside of the door

However, given my previous health hopefully they wouldn’t bother.

I wish I’d signed an official advance directive at the surgery but they seem to disapprove.

[JackJackIncredible]

Apologies @mykingdom
I forget I have quite a different view and I found it all very traumatic and I don’t know why I read these threads as it upsets me.
I had the most fantastic care and didn’t suffer unnecessarily or in any unneeded pain but ICU feels pretty brutal, both physically and psychologically.

[mykingdom]

@JackJackIncredible Yes you are right, certain procedures only need laryngeal airways but it is still somewhat invasive and not done to anyone who is awake. I am an anaesthetist, I was trying to allay fears of people being intubated whilst aware of the tube being inserted.

[CocoCorona]

Thanks @MozzchopsThirty. Just googled laryngeal mask and I think that’s exactly what it was. My throat felt sore afterwards.

[beesbugsbutterflies]

My mom who was 65 passed away last year and for the last 5 days of her life she was put on a ventilator. I can never forget seeing her with all those tubes attached and the noise the machines made and the smell. We were allowed to visit her once a day. She was sedated throughout but they reduced the medication time to time and I remember she tried to open her eyes. Once when I called her she started crying, It wasn't the tears but her face was shaking. I will never forget any of these for the rest of my life, she was such a beautiful gentle soul.

[WhentheRabbitsWentWild]

I have had a few OPs whilst being under and usually recall being in the pre med room and then the recovery , with a oxygen mask on and nurses there.
Except once when I woke to see the anethesist and the doctor alongside Apparently my blood pressure had fallen a few times and it was taking an unusual amount of time for me to wake up.
Didn't prevent me being on my feet some hours later and home two days on .
I suppose I had been Intubated but have no memory of it of course.

[MozzchopsThirty]

@CocoCorona you would have had a tube or if short surgery something like a laryngeal mask airway so quite possible you remember someone removing it

You're normally just rousable at that point and often go back to sleep