"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.

Normal breathing uses negative pressure - your diaphragm moves down, your intercostal muscles in your ribs move upwards and outwards, which creates negative pressure. The negative pressure draws air into the lungs.

Ventilation is usually intermittent positive pressure ventilation (IPPV). Air is forced down a tube into the lungs. It's a bit like filling a balloon - the initial inflation needs a lot of pressure, then the pressure can ease off once the airways are open.

Ventilator settings need to be set very carefully. It's usual to use predicted body weight to set pressures and volumes. Giving too much air or too much pressure will damage the lungs. But if there is lots of fluid or mucous in the chest, the pressure required will be higher.

Oxygen is toxic at high levels, surprisingly, and when o2 is above 50% there can be changes in the lung structure as a result. However, if it is necessary, it's necessary.

None of it is ideal. The ideal is breathing 12-20 breaths per minute, with 95% oxygen saturation, on room air. The further someone gets away from that, the more intensive support they'll need.

PTSD caused by a spell in ICU is not uncommon. It's well documented.

If there's no life left for you to live because of the destructive forces of an intervention then your life has not been "saved". I think it's time we started to consider that properly rather than brutalising people because we can't face our own mortality.

Hi, I just wanted to give my experience. I have been on ventilation, following being in a comma for 7 weeks. It is unpleasant, but I wouldn't describe it as painful or brutal. It takes ALOT to recover from it and it isn't great but at the point you are actually on the ventilation, I cant say it hurt etc. I just wanted to say that incase it comforted anyone who's family member is on ventilation or will be in the future.

@AnonymousWoman that article is nonsense daily mail bullshit

I'm an ex ITU nurse

Patients are sedated and paralysed before intubation as you would be for surgery.
If they require ventilation for longer than 7 days then a tracheostomy is performed which is much better for breathing (closer to the lungs, less dead space) and you can wake patients with a trache and they can be kept comfortable

There is no excuse for someone being in pain and you can keep BP maintained without dropping sedation or painkillers.
Patients are given a sedation hold every day to prevent them being overloaded with sedative and being kept 'too deep'

They're not without risks, high pressures can cause lung damage (pneumothorax) and there's an increase in ventilator acquired pneumonia's

Sorry about the tabloid link, but embedded part way down it is a video of an ICU professor speaking on BBC earlier this month, and he describes al the other stuff that may need to be done too and for ventilated patients

www.express.co.uk/news/uk/1266052/Boris-Johnson-ICU-hospital-coronavirus-organ-failure-news-mystery-latest

The head of the Sepsis Trust has also been speaking this week about the extensive support that patients who have been ventilated for a considerable time afterwards

I acknowledge that others have had different experiences and PTSD must be an awful thing to go through, but it isn’t the case for everyone who is ventilated.

nopenothappening it was the PTSD that made it all brutal for me. It was such a massive thing to get my head around.

Organ I found the hallucinations from the morphine scary, total lack of control.

PTSD is more common in those who remember the least from their ITU stay (ie went to work in March and woke up in August type of thing)

They are starting to keep patient diaries now and take photos to help with this

@OrganTransplant123

Do you mind me asking if you were intubated post surgery (assuming it was an organ transplant) and if so, was it a planned transplant?

^^ Oops meant to say because I wonder if the unexpected nature of ICU contributes to PTSD?

I watched Pandemic on Netflix and it included someone coming off one after fighting a flu like virus.

I Haven’t forgotten it since.

I don’t mind you asking at all JackJackIncredible. I had been completely fit and well until one month beforehand. Unbeknownst to me my liver was failing.

To cut a long story short, I was in hospital for a month and then they came one evening and said they had a possible liver for me. I had bloods, chest xray and then was wheeled down to theatre.

It was all very sudden in that respect but a different experience to someone who is driving along, has an accident and wakes up in ICU.

Thank you for sharing your story, OrganTransplant. Sounds like quite the shock. I’m glad you got your liver and hope you are as well as can be.

My illness was very sudden, from fine to nearly dying in less than 24 hours and I lost a lot of memory. I think the combination of the suddenness and the fact that I had a memory problem contributed to PTSD.

Can I ask a stupid question if anyone can answer. I had a D&C many years ago and was sedated. I’m sure something was pulled out of my throat as I came back around. Was I on oxygen or ventilator? Are operations done using ventilators?

Thanks to everyone who's shared their own and their family's experiences. I've found this helpful as someone who hasn't experienced being ventilated or having a loved one in that position (other than as part of routine surgery).

There's been a lot of outrage about the suggestion that frail elderly or disabled people might not be offered ventilation if they fall ill with COVID 19. It's been suggested that this is backdoor euthanasia. Is it not more likely that it's a clinical judgement that the very frail wouldn't survive being sedated and intubated, and if death is more or less inevitable as a result of the infection, it's kinder to them to let them go in the community.

to all those for whom this had brought back bad memories.

Thanks JackJackIncredible. Liver still going strong 16 years on.

That must have been a shock. I had time to get used the hospital routine as it were. Endless blood tests, noise, lack of privacy- endless questions about bowel movements! Hope you are doing well now.

@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

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.

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.

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

@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.

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.

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.

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?

@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.