Ventilators in times of COVID-19: Life-saving machine or a 'killing' unit?

Written By: Praphul Singh Source: WION Web Team
Place: New Delhi, Delhi, India Published: Apr 21, 2020, 07.05 PM(IST)

Low cost ventilators Photograph:( PTI )

Story highlights

According to an estimate projected by in a report by Center for Disease Dynamics, Economics and Policy, India will need an estimated 1 million ventilators to address the peak of coronavirus. 

In a recent study published in The Lancet experts have projected the demand for ventilators at the peak of the coronavirus outbreak in the USA. ''

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According to the report, at a basic reproduction rate of 2.5, 1,15,001 (ranging between 101 006–131 770) invasive ventilators and 89,788 (ranging between 78 861–102 880) non-invasive ventilators would be needed, on average at the outbreak peak.

The estimates used to project the numbers include recent evaluations of coronavirus patient’s hospitalization and data of patients in ICU requiring ventilation. 

The study further elaborates that 69,660 out of 98,105 invasive ventilators in the USA are already deployed for non-coronavirus patients, before the spread of the pandemic. It essentially means that only 28,445 invasive ventilators would be left for coronavirus patients.

Consequently, at least 45 341 (IQR 31 346–62 110) additional units would be needed for the surge at the peak. Similarly, of the 22,976 non-invasive devices, an estimated 12,499 units would be available for COVID-19 patients. As a result, a minimum of 77,289 additional units would be needed at the peak in the USA. 

The startling numbers projected in the report reveals how ill-prepared the USA really is, once coronavirus peaks in the country. A point worth being noted here is that these available ventilators include additional units in stockpile or storage.

The USA is not alone in facing the crisis. As the pandemic spread, countries around the world started to push to get more ventilators to treat coronavirus patients. 

According to an estimate projected by in a report by Center for Disease Dynamics, Economics and Policy on March 24, India will need an estimated 1 million ventilators to address the peak of coronavirus.

The shortfall has resulted in a race to develop low-cost ventilators in the country. India is also looking to import ventilators from countries like China, South Korea to meet the required numbers of units.

But, with growing concerns among health experts on the usage of ventilators and data suggesting higher mortality rate among patients on ventilators than the normal mortality rate, leaves a big question unanswered. Are ventilators saving lives or killing more people?

As health officials around the world are working day and night for a possible vaccination to cure COVID-19 responsible for the death of more than 171,652 around the world, some doctors are moving away from using ventilators when they can.

High death rates on most advanced breathing support in the UK, New York, etc. raises questions on the effectiveness of critical care for patients in ICU who are fighting for their lives. 

The reason - some hospitals have reported unusually high death rates for coronavirus patients on ventilators, and some doctors worry that the machines could be harming certain patients.

The evolving treatments highlight the fact that doctors are still learning the best way to manage a virus that emerged only months ago. They are relying on anecdotal, real-time data amid a clutch of patients and shortages of basic supplies.

Mechanical ventilators push oxygen into patients whose lungs are failing. Using the machines involves sedating a patient and sticking a tube into the throat. Deaths in such sick patients are common, no matter the reason they need breathing help.

Generally speaking, 40 per cent to 50 per cent of patients with severe respiratory distress die while on ventilators, experts say. But 80 per cent or more of coronavirus patients placed on the machines in New York City have died, state and city officials say, reported by Associated Press. 

Similar reports have emerged from China and the United Kingdom. One UK report put the figure at 66 per cent. The ICNARC (Intensive Care National Audit & Research Centre, UK) report looked at the first 775 patients who had fallen critically ill with COVID-19 across 285 intensive care units.  

Of the 98 patients who needed advanced respiratory support when their lungs started to fail, just 33 patients lived (34 per cent). A very small study in Wuhan, the Chinese city where the disease first emerged, said 86 per cent died.

The reason is not clear. It may have to do with what kind of shape the patients were in before they were infected or it could be related to how sick they had become by the time they were put on the machines, some experts said. But some health professionals have wondered whether ventilators might make matters worse in certain patients, perhaps by igniting or worsening a harmful immune system reaction- that’s speculation. ''

But experts do say ventilators can be damaging to a patient over time, as high-pressure oxygen is forced into the tiny air sacs in a patient’s lungs.

“We know that mechanical ventilation is not benign,” said Dr Eddy Fan, an expert on respiratory treatment at Toronto General Hospital. 

“One of the most important findings in the last few decades is that medical ventilation can worsen lung injury — so we have to be careful about how we use it.”

The dangers can be eased by limiting the amount of pressure and the size of breaths delivered by the machine, Fan said in an interview to Associated Press. 

Dr Luciano Gatinoni, an expert in anesthesiology and intensive care at the Medical University of Gottingen, in a letter to the editor published in Intensive Care Medicine, wrote that coronavirus patients in Italy showed symptoms subtly but significantly different from of other patients in respiratory distress. 

“All we can do ventilating these patients is "buying time" with minimal additional damage: the lowest possible PEEP [Positive End Expiratory Pressure] and gentle ventilation,” Gattinoni added.

“The ventilator is not therapeutic. It’s a supportive measure while we wait for the patient’s body to recover,” said Dr Roger Alvarez, a lung specialist with the University of Miami Health System in Florida, who is a leader in the effort to use nitric oxide to keep patients off ventilators for as long as possible said, while speaking the Associated Press.

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