A ventilator — some call it a breathing machine — is a device that pumps air into the lungs of a patient with severe respiratory failure.
It helps the patient breathe when they can’t do it on their own through a breathing tube, also called an endotracheal tube.
Using an intubation process, doctors use a laryngoscope with a tiny camera that provides a picture on a screen of the vocal cords to help guide the endotracheal tube down through the mouth and into the windpipe, also called the trachea, then connect it to the ventilator.
A capnometer, a device attached to the tube that measures carbon dioxide concentrations in respired gases, ensures that the patient’s airways are receiving oxygen.
It’s used in emergencies but also used routinely to support breathing for patients undergoing surgery.
But you can’t eat. You can’t drink. You can’t talk.
And for those with a severe case of COVID-19, which can cause catastrophic damage to the lungs, this $40,000 piece of medical hardware could represent the last best effort to keep the patient alive.
Pulmonologist Dr. Frank Mazza, chief of critical care and chief of medicine at Resolute Health Hospital in New Braunfels, took time to demonstrate the intubation procedure using a medical manikin during a Herald-Zeitung visit to the facility this week.
“In the (intensive care unit), commonly, we use them in people who have a limited respiratory reserve, like someone who has (chronic obstructive pulmonary disease) who gets pneumonia, they get tipped over the edge,” Mazza said. “We’ll put them on the ventilator to assist their breathing until they get better enough that we can wean them off it and have them breathe on their own.”
A ventilator doesn’t cure COVID-19 or other illnesses that cause breathing problems, but it’s designed to help the patient survive while the body fights the infection.
Mazza said he prefers using a Macintosh laryngoscope, which has a curved blade that allows exposure of the larynx by positioning the tip in the vallecula, anterior to the epiglottis and lifting it out of view. The laryngoscope is designed to lessen the difficulty of exposing the larynx to pass an endotracheal tube into the patient’s trachea.
Some health care professionals use a laryngoscope with a straight blade, called the Miller blade.
And it’s uncomfortable for the patient.
“We have to sedate people who have endotracheal tubes in them,” Mazza said. “Frequently, we have to paralyze them as well, medically. The respiratory therapist plays a very important role in terms of monitoring the ventilator and making sure that there are no complications because the patient is heavily sedated and sometimes paralyzed. If this term were to become dislodged, it’s a disaster, and the patient could die. They’re real experts in maintaining the airway.”
If the patient is awake enough, Mazza said, they can take breaths on their own, but the machine can control the breathing process if necessary in different ways.
“It’s a very sophisticated machine, and it’s microprocessor driven,” he said. “In the simplest form, if someone is not breathing, let’s say they took a drug overdose and they weren’t breathing, but otherwise the lungs were fine, the machine basically pushes air in and out.”
When someone is critically sick, like a COVID-19 patient, the machine does other things as well.
“It delivers oxygen, but it also controls how much pressure that we put in at any moment in time,” he said. “We can set how much air we give. We can set how fast we give it.”
Depending on the patient’s circumstances, health caretakers may have to constantly make adjustments to the ventilator. The machine is a life-saving device, but a sobering reality has emerged during the pandemic that some patients do not survive.
“In COVID patients, we have to (make constant adjustments) because COVID patients don’t die because of the virus,” Mazza said. “They die because the virus induces changes to their immune system. Their immune system then goes wild, and that damages their lungs. For those COVID patients that don’t survive, the reason they die is because those lungs don’t heal, despite everything we do for them. We have a number of options to treat them, and hopefully, they respond, but not everybody does.
“During the time that they are in the ICU, and we have them on a ventilator, we are constantly making adjustments, trying to improve their oxygen level, trying to do it safely without their lungs collapsing, because people who have COVID tend to have very fragile lungs. Even though we have ways of minimizing the pressure we give on the machine, their lungs are still so fragile that they collapse. They are very tricky to take care of.”
During the surge in August and September, likely fueled by the delta variant of the virus, hospitals in Comal County were reporting that the vast majority of infected patients hospitalized were unvaccinated.
The COVID vaccines are “very effective,” Mazza said.
“We would like to see everyone who is eligible to take the vaccine,” he said. “We have many people for one reason or another not chosen to get the vaccine who have gotten very sick and survived and have regretted the decision not to get the vaccine. We think it’s the best thing you can possibly do but in addition to the vaccine, staying out of environments that put you at risk of being exposed to the virus, like being in large gatherings of people indoors, being around a lot of people who are unvaccinated.”
Do masks offer some benefit?
“Probably a little bit,” Mazza said. “They’re not a panacea. And if you put a mask on, you’re protecting me against you. You’re not protecting you against me. Social distancing probably protects you a little bit because the virus is spread by means of coughing droplets which tend to fall flat within a few feet.”
Then there’s something Mazza wants everyone to know.
“If you catch COVID and you’re a high-risk patient or elderly patient, within the early days of having COVID, you can get an infusion that is provided free by the government called monoclonal antibodies that 80% of the time will prevent you from getting a severe case,” he said. “It’s staggering and tragic when we see over and over again in patients who come into the hospital who got COVID, they weren’t very sick, were sent home and then a week to 10 days later, they come back to the hospital because they have an immune response. And now they’re very sick and may have to go to the ICU, may have to go on a ventilator and may die, when they could have received this monoclonal antibody infusion that could have prevented them from coming back. People need to know this is available to them and doctors who are taking care of these people hopefully saying to them to go and get the monoclonal antibody infusion.”
State officials have established and expanded antibody infusion centers in communities across the state over the past several months. COVID-19 antibody infusion treatment can prevent a patient’s condition from worsening and requiring hospital care.
The treatment is free and available to residents who test positive for COVID-19 and have a referral from a doctor.
Residents can visit meds.tdem.texas.gov to find a therapeutic provider.