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.

Coronavirus: What You Need to Know!

Background

On 31st December 2019, reports of a new virus originating in Wuhan City, Hubei Province of China spread across the world. The Chinese authorities identified this strain as coronavirus, part of a family of viruses usually cause upper respiratory diseases, from the common cold to rarer diseases like SARS and MERS. Due to the nature of this virus, most people may have experienced some low-level symptoms at some point in their lives, from runny noses, headaches, coughs, to fever and a general feeling of being unwell.

 

Current Status – Updated

As of January 2020, this latest outbreak of the virus has been named 2019-nCoV. This latest strain also confirms that human-to-human transmission is possible, with the current toll of infected people has hit close to 6,000 people, mostly in China. At the moment, the range of severity of this disease is causing concern- people suffering from poor health appear to be at greater risk of some of the more serious symptoms, while others have only experienced mild illness.

As we approach mid-April, the latest report in India has had 8988 active cases, according to the Government of India’s dedicated COVID-19 website.  The virus has hit over 210 countries, with USA leading the count at 587,173 cases. Europe has also been badly hit, with Spain reporting 172, 541 cases and Italy and France following at 159,516 and 136, 779 cases. Germany and UK are right behind them, thus making up the top five most affected countries.

All across the world, governments are instituting strict self-isolation rules. America declared a national emergency mid-March, while the Indian government has extended the initial 21-day lockdown to a total of a 42-day lockdown. The WHO (World Health Organization) has also declared coronavirus a pandemic– a disease that impacts a huge population, while spread across a large geographic area.  The Indian Government has created a special website that provides real-time and accurate updates on the spread of the virus.

 

Why is it Concerning?

According to the WHO’s latest reports, there have been over 1.7 million confirmed cases of the disease, with the death toll at over 110,000. The impact of this disease surpasses that of SARS epidemic, which hit the world in the early 2000s. Do not mistake the two diseases for being the same- while they may emerge from the same family of viruses, each illness is entirely different in its symptoms, effects, and impact.

Unlike other diseases, COVID-19s highly infectious nature, along with the lack of information on this virus, makes it very difficult to study and cure. Doctors and healthcare workers are still trying to fully understand how the virus spreads and affects the body.

 

How is it Spread?

The coronavirus that causes COVID-19 is transmitted mostly through person-to-person contact. According to the CDC, simply being near an infected person increases your chances of catching the disease. Close physical contact with a known COVID-19 patient is strongly discouraged at the moment. The saliva of an infected person contains the disease, which means any respiratory droplets, like those that occur due to sneezing, coughs, talking, can spread the disease further.

It’s not enough to steer clear of infected patients. You can also be a carrier without showing any signs of the infection. Carriers are able to spread the disease, even though they aren’t affected by the illness themselves. Due to this, social distancing and self-isolation are the need of the hour.

 

Symptoms

This virus causes pneumonia, with patients suffering from cough, fevers, and difficulties in breathing. The typical incubation period for this between two to ten days, and starts with a general feeling of being unwell. Depending on the severity of the infection, there can be organ failure, respiratory failure, or even death.

Even now, the only way to really know if someone has Coronavirus is to test them. A lot of symptoms mimic those of the common flu:

  • Dry cough,
  • Fever,
  • Body aches,
  • Shortness of breath

 

2 Symptoms (3)

Some people also experience sore throats and a runny nose. These symptoms initially seem mild, but some people might be hit with more severely.

 

Who is at Risk?

Coronavirus can affect people of all ages. However, it appears to impact people with pre-existing conditions or elderly people more seriously. As of now, the World Health Organization has reported that 1 in 6 infected people get seriously sick. According to the CDC, at-risk groups include

  • People over 60 years of age
  • Longtime smokers, since the disease attacks the respiratory system
  • People with HIV
  • People with chronic lung disease
  • People with moderate to severe asthma
  • People with severe obesity
  • People who are immunocompromised
    • Includes people going through cancer treatments, smokers, having immune deficiencies, or consuming any immune weakening medication
  • People with diabetes
  • People with liver disease
  • People with chronic kidney disease undergoing dialysis
  • People of all ages with underlying medical conditions

 

Debunking Myths

Currently, there is a lot of misinformation being spread around this virus. Social platforms like Pinterest, Quora, and text applications like Whatsapp, are cracking down on the spread of false facts. During this time, we encourage you to seek accurate and updated information from verified sources, like the Center for Disease Control (CDC) and the World Health Organization (WHO), or the Indian Government’s dedicated information-sharing resource around COVID-19.

Below, we have cleared up some misconceptions around COVID-19 (all information has been sourced from the WHO and MyGov)

  • Coronavirus is NOT transmitted through mosquito bites
  • Coronavirus CAN spread in hot and humid regions
  • There is NO evidence that dogs/ cats can spread the virus
  • Hair-dryers, steam/ water vapour, hot baths are NOT cures or prevention for the virus
  • Typical flu vaccines are not a guaranteed protection against COVID-19
  • Antibiotics are NOT effective against viruses
  • Eating garlic/ homeopathic remedies are NOT proven solutions against this virus
  • There is NO cure or vaccine at this time

 

Precautions/ Tips

Stay safe and maintain the quarantine with all your efforts.

If you need to step out, cover your face properly with a mask, which helps reduce the potential of catching the illness. Cloth masks, which are effective for this, can be purchased or even made at home.

If you need to cough in public, cough into your elbow, not your hands.

Ensure that you’re washing your hands regularly, for a minimum of 30 seconds.

Choose alcohol-based sanitizers over non-alcohol-based, as the alcohol is more effective against viruses.

The Government of India has also released a COVID-19 tracking app named Aarogya Setu, which helps citizens keep track of the virus’ spread in their areas.

 

3 Prevention (1)

 

Warning Signs & Resources

If you’re experiencing mild symptoms, you need to immediately self-isolate for 14 days. However, if you fall into an at-risk category, and your symptoms are severe, get in touch with the government helpline at 011 – 23978046/ 011- 23971075. You can also reach out at ncov2019@gov.in. There are private testing options as well. You can check this list to see the options in your cities.

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