"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.

[JackJackIncredible]

@mykingdom

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

[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.

[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

[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.

[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?

[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.

[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

[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.

[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.

[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.

[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!

[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.

[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

[mykingdom]

@kevintheorangecarrot Nothing has quite been established.

[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 !!

[MozzchopsThirty]

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

Not by any actual intensivists