I don’t want a ventilator if I get very sick with COVID-19.
Much of the focus of many state governments has been on the need for more ventilators to treat severely ill patients with the novel corona virus. I believe the ventilator issue needs a closer look.
Are they actually helpful? Are they the only thing that can be done for the critically ill? How much staff is needed to operate them? What are the medications that need to be used with them? What is it like for the patient to be on a ventilator?
I am a 70-year-old retired MD. I did my residency in internal medicine at a teaching hospital with a busy ICU. I then practiced for many years in a community hospital with a small and busy ICU. I managed patients on ventilators many times. Some survived, some did not, depending on their underlying reason for needing the ventilator in the first place. I came to believe that it was sometimes inappropriate care, not even considering the expense both in money and resources of ICU care to the overall health care system. Over the years, the prevailing approach to resuscitation and ventilator use did evolve in a direction that made more sense. Patients were given the choice of do not resuscitate (DNR) orders and later, medical orders for life sustaining treatment (MOLST) that allowed more specific advance directives such as oxygen, antibiotics, feeding tubes and, yes, ventilators.
I believe the general public has an overly optimistic view of resuscitation in general, and now ventilators. We are told they are “life-saving” and “a matter of life or death.” On medical TV shows, the rate of successful resuscitations and full recovery is much more optimistic than it truly is. Although I don’t think there are any solid statistics yet available on the long-term survival of COVID-19 patients severely ill enough to require ventilators, I have read in the lay literature that the mortality rate for those who wind up on ventilators is 50 percent to 80 percent, often after prolonged ICU stays of several weeks. And those who do “recover” often do not return to their previous state of health.
An article from the Washington Post dated April 3 points out that “for those who manage to defeat the virus, many will suffer long term physical, mental and emotional issues, according to a staggering body of medical and scientific studies. Even a year after leaving the intensive care unit, many people experience post-traumatic stress disorder, Alzheimer’s-like cognitive deficits, depression, lost jobs and problems with daily activities such as bathing and eating.”
So what is it like to be on a ventilator? Most people know that you will be isolated from friends and family in the ICU, horror enough. You will also be entubated with a plastic tube inserted via the mouth or nose into the trachea. This procedure is unpleasant enough that people have to be given paralytic agents and sedation. And the medications needed are another thing that is in short supply. If they somehow wake up, they will “fight the tube” and do everything they can to rip it out, thus requiring physical restraints. Depending on how the “vent” is set to deliver oxygen, there may be no way to take your own breaths. After a few days of being entubated, a tracheotomy is required to prevent damage to the upper airway and vocal cords — another risky procedure. The levels of oxygen and pressure sometimes required can “burn” or otherwise damage the lungs, making recovery even less likely, especially after prolonged time on the vent.
I do not want to die but if I do, I want to be comfortable and not on a machine. So, no ventilator for me.
Constance Lentz, MD, retired, lives in Montague