How a Ventilator Can Help People With COVID-19

Some people who get COVID-19 will need to rely on this machine to stay alive.

Ventilators have been a popular topic resurfacing throughout the COVID-19 pandemic, with concerns such as an inadequate supply of ventilators or which patients should get access to ventilators being raised.

So what exactly is a ventilator, and which COVID-19 patients need it?

According to the American Thoracic Society, a ventilator (also known as a mechanical ventilator, respirator, or breathing machine) is a life support treatment that helps people breathe when they can't do it on their own. This machine gets oxygen into the lungs and the body and helps get rid of carbon dioxide through the lungs.

A ventilator is connected to the patient through a tube placed into their mouth or nose and inserted into the windpipe (a process known as intubation). In some cases, patients have surgery to have a hole made in their neck, and a tracheostomy or "trach" tube is inserted through the hole into the trachea. The ventilator then blows gas (consisting of air, plus oxygen if required) into the patient's lungs.

According to the American Thoracic Society, a ventilator can help a patient by doing all or some of their breathing, and it's superior to a mask and other devices because it can deliver higher levels of oxygen. It can also provide positive end-expiratory pressure (PEEP), which helps hold the lungs open, so the air sacs do not collapse. If the patient has a weak cough, the tube in the windpipe also makes it easier to get rid of mucus.

COVID-19 and Ventilators

SARS-CoV-2, the virus that causes COVID-19, can damage the respiratory system because it infects the cells along the airways. The virus specifically invades the cells in part by attaching to a specific cell receptor, called ACE-2, using the receptor as a doorway into the cell. The virus then takes over the cell's ability to make copies of itself and instead produces more copies of the virus to infect other cells.

According to the National Heart, Lung, and Blood Institute, people with chronic heart, lung, and blood diseases may be at risk of severe COVID-19 symptoms. These symptoms include pneumonia, acute respiratory distress, and acute respiratory failure. Patients who experience severe respiratory problems due to COVID-19 may require oxygen therapy, a ventilator, or other airway support.

"In certain patients with COVID-19, the virus infection causes pneumonia and severe inflammation that cripples the lung's function," Harvard-trained internal medicine specialist William Li, MD, told Health. "In these patients, having a ventilator available to support the patient can make the difference between life and certain death."

When treating a patient with COVID-19, a ventilator allows the medical team to support a patient's breathing function. "Even if the lung is failing, a ventilator can provide enough support and buy enough time for the medical team to help the patient overcome the infection, until the point where their own lungs are able to regain function," said Dr. Li.

The Changing Need for Ventilators During the Pandemic

While several variants of SARS-CoV2 have been identified, not all have had the same effect on patients. When it first appeared in 2019, COVID-19 was most commonly associated with symptoms such as cough, fever, and shortness of breath. The early variants of SARS-CoV2 tended to lead to more serious lower lung issues that could lead to dangerously low oxygen levels.

However, the Omicron variant, which was identified in late 2021, produces more upper airway symptoms in patients, such as wheezing and coughing, and fewer serious lower lung issues that require the use of a ventilator. Fewer patients with Omicron develop acute respiratory distress syndrome, a condition in which fluid collects in air sacs of the lungs, leading to fewer patients requiring the support of ventilators. In fact, according to data released by the Centers for Disease Control and Prevention (CDC) in January of 2022, the percentage of COVID-19 patients needing mechanical ventilation was about half of what it was during the winter of 2021.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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