Ventilators: Life Savers in Times of COVID-19

A Ventilator is the most widely used short-term life support technique. It has been proven to be the defining intervention of intensive care medicine. The outbreak of COVID-19 has led to huge demand for ventilators, as infected patients especially those who suffer acute respiratory distress syndrome (ARDS) are in a dire need of this life support system to aid their respiratory functions.

Importance of ventilator in times of COVID-19

Mild forms of COVID-19 cause symptoms of breathing problems, which can be supported by non-invasive methods. But in severe cases, the disease damages the lungs leading to pneumonia, where the patients suffer from high fever and breathing difficulties. In such cases, mechanical ventilators are often used. They assist the patient’s breathing by pumping oxygen into the lungs and expelling carbon dioxide.

Due to the coronavirus outbreak, there has been an acute shortage of many medical essentials such as hand sanitizers, face masks, etc. The need and importance of the ventilators have also suddenly amplified. If the proper timely assistance is not provided, patients have a higher risk of mortality.

 

Shortage of ventilators- what India is doing

India has been confined to complete lockdown to control the further spread of the disease. In the face of this pandemic, the sudden increased requirement of essentials like face masks, hand sanitizers, and ventilators has caused a worldwide shortage. To help increase production, many Indian companies have come together to help.

Amongst the many sectors contributing to the cause, Indian Railways has stepped up tremendously, from turning coaches into quarantine zones and helping to deliver essential products across the country.

The  World Bank also reported on how Women Self Helps Groups (SHG) have stepped up to contribute to this crisis. They are playing a critical role in helping to meet the shortfall of protective equipment like masks, sanitizers, and other PPE.  Over the past couple of weeks, these women have produced more than 1 million cotton masks, helping equip police personnel and health workers, while being able to earn a living.

According to the CDDEP, “the researchers estimated that India has approximately 1.9 million hospital beds, 95 thousand ICU beds, and 48 thousand ventilators. Most of the beds and ventilators in India are concentrated in seven states – Uttar Pradesh (14.8%), Karnataka (13.8%), Maharashtra (12.2%), Tamil Nadu (8.1%), West Bengal (5.9%), Telangana (5.2%) and Kerala (5.2%)”.

In times of need, India has always succeeded in making desi-innovations which actually proves to be successful. Indian start-ups are coming up with unconventional systems to meet the needs.

Such innovations help the country and provide much needed boost to face the situation and a hope that we can cope up with the crisis.

 

What is a Ventilator

A ventilator is a medical device used to provide breathing support for ill and critical patients. It is designed to move breathable air into and out of the lungs, to provide breathing for a patient who is physically unable to breathe, or breathing insufficiently. Since COVID-19 virus directly attacks the lungs of the patients, they need an external support system to help them breathe.

 

The function of a ventilator

When it comes to life-saving moments, every second is critical. Ventilators pump air into the lungs and also support the exhalation of carbon dioxide from the lungs; this process is known as ‘ventilation’. Mechanical ventilators are used in situations where the patients require continuous ventilation, i.e. COVID-19 affected patients.

 

According to NHLBI, some other cases where mechanical ventilators are primarily used are:

  • During surgery, when a patient is under Anaesthesia, to provide continuous breathing support
  • Brain injury or Stroke
  • Pneumonia and other advanced lung infection due to COPD or ILD

 

Types of ventilators

There are mainly two broad categories of Ventilators. It further has some subtypes under mechanical ventilators.

1- Bag Valve Mask (BVM)

2- Mechanical Ventilator

Bag valve mask

Due to the current pandemic, ventilators and other respiratory devices are more crucial than ever. Ambu-bags or bag valve masks (BVM), are manual respiratory devices, used to provide pressure ventilation to people who are not breathing or having breathing difficulty. These are typically used in situations where access to a ventilator is difficult, i.e. emergency settings or out of hospital situations. They are also used to provide temporary support to the patients in hospitals where a mechanical ventilator is available. However, it has some shortcomings, including inconsistent delivery, leakage, and gas pressure on the stomach. Overall, these have been proven useful for out of hospital or emergency cases.

Mechanical Ventilator

According to the NCBI, a mechanical ventilator supplies oxygen and removes carbon dioxide from the patient through a breathing tube. Doctors can make the necessary adjustments based on the patient’s needs. The machines mimic the natural breathing process by providing a steady supply of gas at a controllable rate. It’s meant to provide breathing support to patients who are unable to breathe themselves.

Two categories fall under mechanical ventilators: invasive and non-invasive ventilation. Invasive ventilation is where the tube is passed through the mouth, such as an endotracheal tube or the skin with a tracheostomy tube. 

Invasive Ventilators

Invasive Ventilators can be further divided into Intensive Care Ventilators, which are mainly for adults, and Neonatal Ventilators for infants.

Intensive-care ventilators — These ventilators have a full variety of features needed to make a unit appropriate for a broad range of intensive care applications.

Requirement: As per NCBI– “patients ventilated by these devices can range in age from neonates to adults and can vary in condition from very critical, unstable patients to relatively stable postoperative patients. While intensive care ventilators are typically used in critical care areas of the hospital, they may be used in other care areas as well”.

Uses: Used for both adults and pediatrics

 

Neonatal ventilators–  It is designed to deliver more precise volumes and pressures required for the infants.

Requirement: Neonatal intensive care ventilators provide ventilatory assistance to premature and critically ill infants suffering from respiratory failure. The infants who have low-compliance lungs, small tidal volumes, high airway resistance, and high respiratory rates need special support through neonatal ventilators.

Uses: Used for premature infants and children weighing up to 30 kgs

Non-Invasive Ventilators

In the case of non-invasive ventilation (NIV), devices with a nasal or face mask are used. The benefit of an NIV is its reduced need for endotracheal intubation and complications related to it. Non-invasive ventilators like CPAP or BiPAP are used at home by people with chronic respiratory difficulties like COPD. Its functionality is simple and easy to handle for people who don’t have medical training.

 

Ventilator vs Respirator vs Intubation

Ventilators and respirators are generally common terms that are often used interchangeably. Both are used to provide breathing support in required conditions. But in light of the growing pandemic, we’ve detailed the key differences below:

Ventilator: A machine that provides breathing support to critically ill patients, like the ones suffering from coronavirus. A ventilator can’t cure COVID-19 but supports the body as its immune system fights the virus.

Respirator: According to GovTech, a respirator is used to provide protection to people working/ living in areas with germs or infections. Vox states that respirators can be as simple as face masks, which help filter out particulates so people are breathing clean air. These are especially crucial for healthcare workers working in hazardous or contaminated zones during the ongoing COVID-19 pandemic.

Intubation: The insertion of a tube into the trachea (windpipe) is called Intubation. Endotracheal intubation permits air to pass freely through the lungs and facilitates the use of a mechanical ventilator.

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