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04/27/2020
Mechanic ventilation
Ventilation in Covid-19 can worsen the condition.
Photo: iStock / sudok1
Why does artificial respiration sometimes worsen the Covid-19 course?
If Covid-19, the disease caused by the Sars-CoV-2 coronavirus, has a severe course of the disease, lung problems often arise – artificial respiration is required. But sometimes the patient’s condition worsens at that time. Why is that?
The Sars-CoV-2 Coronavirus is still fairly new to us, we have to learn and learn a lot about the virus and the disease that Covid-19 caused. One thing is clear: Most infections are easy, but the virus can also affect various organs, especially the lungs. There Covid-19 can cause pneumonia, which is often atypical. Patients believe they can still breathe well, but the lungs are not absorbing enough oxygen. At some point it must be treated intensively and artificially ventilated. But there are growing signs that Covid-19 may be even more critical with artificial ventilation. The condition of ventilated patients worsens. Why this is so, now there are new ideas.
Artificial respiration can intensify the course of crown disease.
Artificial respiration is a heavy food for the body. The lungs are pumped full of air under pressure, the cardiovascular system has to adapt, the lungs stretch unnaturally, which can damage sensitive lung tissue – the list is long. A report has recently been released showing that the mortality rate of artificially ventilated Covid 19 patients is quite high. But oxygen is vital. If it cannot be absorbed and the carbon dioxide produced in the body cannot be exhaled, there is a risk of serious bodily harm even suffocation. Therefore, scientists around the world are looking for reasons why ventilation of patients with coronavirus does not always seem to be the best way, and alternatives.
Scientists are currently investigating exactly what Covid-19 or coronavirus does in the lungs. You can find the latest findings here. If Covid-19 hits hard and the patient lacks oxygen as a result, artificial ventilation is provided. There are different ways of doing this.
One of the most obvious interventions is invasive ventilation with intubation, in which a tube is inserted into the trachea through the mouth or nose. This is possible for several weeks or months, but the risks increase over time, and the experience is not pleasant for the patient, even if he is usually put into an artificial coma. But over time the risk of germ infection through the foreign body increases.
Non-invasive ventilation works through a respirator mask, through which air is pumped to the lungs with pressure. However, this ventilation is also not pleasant: the patient gets everything here. Pressure marks through the mask, dry mucous membranes, air in the stomach are part of the side effects. In the long run, the lungs may be stressed.
And the problem of deterioration in the condition of Covid-19.
Worse health: that could be the reason
Several researchers around the world have already addressed this problem. Two experts in intensive care, pulmonary physiology and pulmonary pathophysiology, as well as mechanical ventilation, have compiled the results and experiences on the effectiveness and impact of ventilation in patients with Covid 19. Luciano Gattinoni of the Medical Center of the University of Göttingen (UMG) and Prof. John J. Marini of the University of Minnesota (USA) in a “Clinical Update”.
The scientists found clues as to what exactly is damaging the lungs. To do this, they used new data from Italian clinics, for example. As a result, the lungs of Covid-19 patients are not as mechanically damaged in the initial phase as in other forms of pneumonia. In this early phase of the disease, significantly less fluid builds up in the lungs than in “classic” pneumonia. The lungs remain elastic and elastic for an unusually long time, those affected do not have problems with inhalation, they do not feel the “resistance” that is typical of many types of pneumonia when inhaled. However, many small blisters are later discovered in the lungs, making it difficult to transport inhaled oxygen into the blood. Patients receive very little oxygen, although they feel that they can still breathe well.
However, since the lungs remain stretchable for so long, experts advise against standard treatment of “normal” pneumonia associated with artificial ventilation at this early stage of treatment.
Doctors are now more careful with artificial respiration.
Instead, his recommendation: If the patient suffers from shortness of breath, the first step should be to make sure that gas exchange and respiration adapt appropriately to the stages of the disease so that the lungs can heal and recover
The unusually long elasticity of the lungs and such an unusual accumulation of fluid in the lungs in Covid-19, that is, only at the edge, in the division between the alveoli and the blood vessels, and later there too, gave them doctors long puzzles. Meanwhile, one acts more carefully. Often, pure oxygen is now administered through a nasal cannula or mask. Due to the faster and deeper breaths, this is very tiring for the patient. At some point, artificial respiration will occur. How to proceed alternatively in the case of serious illnesses should now be found out on the basis of the research results.
If you are concerned about pneumonia, you can try to prevent it. However, it is unclear whether these tips will also help with a coronavirus infection, because there is unusually very little water in the lungs and less mucus that can be coughed up.
By the way, if you don’t want artificial respiration, you can also do it in a living will! And to keep you healthy from the start: this is how you protect yourself against the corona virus
Here you will find the results of the study, published on the JAMA Network.
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