VANCOUVER -- As beleaguered medical professionals care more seriously ill COVID-19 patients in B.C. hospitals than ever before, those with first-hand experience with ventilators are sharing the dangerous and even life-altering fallout facing patients who’ve relied on the machines.
Despite intensive care units overflowing, B.C.’s Health Minister Adrian Dix has assured the public there are enough ventilator machines to support the sickest patients through the pandemic’s third wave. Still, the numbers have done little to capture the harsh reality and dangers that come with what doctors consider a last resort.
“We know when we commit a patient to a ventilator we’re committing them not just to being on a breathing machine, but to all the complications that can go along with that as well,” said St. Paul’s Hospital ICU physician, Dr. Ruth MacRedmond, who said high-flow oxygen is the first step to help struggling patients.
When a COVID-19 patient can no longer breathe on their own or their lungs don’t absorb enough oxygen, ICU doctors have to make a decision, and it sometimes happens quickly, leading to an intense procedure.
The patient is heavily sedated and paralyzed so they can’t fight the tube, which is pushed into their mouth, down their throat and past their vocal cords into their airway. Once in place, the ventilator at the patient’s bedside can force air and oxygen into a patient’s lungs through a network of flexible tubes.
“For the first while, at least, they’ll be heavily sedated and that kind of gives the team and the medications a chance to work,” said respiratory therapist Ryan Haluk, who works closely with doctors before, during and after the patient is intubated.
Respiratory therapists closely monitor patients’ lung function. When it starts to improve, they lighten up the sedation, but that can lead to a panicked response from the patient.
“It’s very common to want to rip that tube out, because when you are in that state it kind of feels like you’re always gagging, it’s really hard to breathe through,” said Haluk. “A lot of people say it’s like breathing through a straw. They feel air-hungry.”
The patient’s perspective
While some patients experience everything from vague memories and impressions to vivid hallucinations and ICU delirium, others don’t remember anything about being ventilated.
“I went in the hospital on March 16. After that, I don’t remember anything,” said COVID-19 survivor Roger Pinette.
The 72-year-old Langley resident was Langley Memorial Hospital’s first COVID-19 patient in 2020, and was quickly taken to the advanced intensive care unit at Royal Columbian Hospital. He spent 40 days on a ventilator that kept him alive.
“When I asked what date it was, I was shocked,” said Pinette. “The only good thing about that was I slept through the bad part. The next shock was I couldn’t move.”
Unable to move or even breath on their own, patients on ventilators lose roughly 10 per cent of their muscle mass each day, and their risk of infection grows. After 10 days, doctors perform a tracheostomy to surgically insert the breathing tube in a patient’s throat, because the damage to their vocal cords is already significant.
“There was no fast healing,” said Pinette, who spent four months in hospital and rehab before he could go home.
The avid fisherman who had enjoyed hikes and an active lifestyle found himself relearning to swallow, eat, speak and walk with the help of dozens of health-care professionals, whom he praised for their dedication and care.
“I’m recovering with an I-N-G,” he said, 13 months after his COVID-19 diagnosis and hospitalization. “I’ve done many face plants. I use a cane. I lost so much strength. I lost a third of my body weight.”
He’s baffled at COVID-deniers and people who don’t take the public health orders seriously. Pinette is supported by a long-hauler clinic and avoids leaving his home as much as possible.
Complications, younger patients and a dire warning
Patients of all ages face serious risks and complications, often for months after they’re released from the ICU, if they survive. A large proportion do not.
“Up to half of patients experience significant weakness, low energy levels, and many patients have psychological aftereffects as well, in terms of anxiety, sleeplessness and even PTSD,” said MacRedmond. “There’s risk of bacterial superinfection, there’s a very high rate of ICU delirium, so patients become disoriented and confused quite frequently, and then lots of other complications, including increased risk of muscle weakness, clotting, bleeding, lots of things that go along with it.”
While those consequences are nothing new for intensive care unit staff, the lasting damage wrought by the coronavirus on patients’ lungs is unique.
Recently, they’ve joined their colleagues in expressing surprise at just how young the patients are in the pandemic’s third wave.
“We had one recently in their 30s, their oxygen got so low their heart stopped and they ended up on a ventilator for a very long time with a lot of invasive procedures,” said Haluk. “It was terrifying, being in my early 30s myself and seeing my same age, healthy and getting affected so badly by this.”
MacRedmond recently saw a 17-year-old patient in her ICU. The teen wasn’t ventilated but needed full oxygen support for several days before they started improving.
“When I start my shift and I’m running down the list and seeing patients who were younger than me, who are quite young compared to the second or first wave when most of the people were a decade or two older than me, (I think), ‘We need to be more vigilant than ever right now because the variants are very transmissible and are very frightening,’” MacRedmond said.
