Moxley said:Big Al 1992 said:
Hey Doc Rev
Can you differentiate ventilate, intubate and what machines are used for what and how they help the patient. The media rattles these terms out there with no context - probably because they have no idea and are just reading a screen. Also read some docs are having better luck aspirating lungs of fluid then putting on a machine - is that a possibility?
Thanks again to you and all the MDs, RNs, PAs, and NPs!
Cardiac/Pulmonary nurse here.
Intubation is the actual process of putting a breathing tube down into the lungs. Mechanical ventilation is what follows: Attaching the tube to a machine that regulates air in and out of the lung. When we say a patient is intubated, in general it is just another way of saying they are on a vent.
The lungs serve two basic purposes: Getting oxygen into the bloodstream and getting carbon dioxide out. This exchange takes place across tiny little capillaries in tiny little air sacs (alveoli) in the lung. This exchange is very delicate and our bodies do an amazing job of regulating our breathing patterns and chemicals in the blood to help keep everything in balance. Our breathing and metabolic processes work hand-in-hand to regulate the gas contents of our bloodstream.
In an illness like covid-19, the virus is attacking lung tissue and the body's inflammatory response to the virus is a double-whammy. What happens is simply that the body can't get enough oxygen into the bloodstream because some of the alveoli are blocked, inflamed, or swollen with fluid. This also can affect the ability of carbon dioxide to get out. Your brain senses this and causes you to breathe harder/faster. Typically we would start support by putting someone on a nasal cannula with extra oxygen to help make the oxygen exchange more efficient until their lungs can heal enough to be able to effectively use the oxygen out of normal air. Typically, we would progress to a face mask, then possibly a BiPAP, before mechanical ventilation. Covid is being treated a bit differently, so will let the doctors explain the reasoning for that.
If oxygen levels continue to drop, or carbon dioxide levels are very high in the bloodstream (due to lack of good exchange in the alveoli) it will require mechanical ventilation to force more air into the lung in a specific, delicate way to rebalance the blood gases and prevent organ damage. Mechanical ventilation is a very complicated process and ventilator settings will be different for each patient's respiratory and metabolic needs.
Sometimes lung inflammation can cause a change in the permeability of those capillaries, where fluid that should be elsewhere can cross into the alveolar space. This is called pulmonary edema. When your lungs have fluid in them they can't adequately exchange gases. This would also, depending on the severity, cause the need for mechanical ventilation. Pulmonary edema cannot be drawn out with a needle (at least I've never seen it attempted, please correct me if I'm wrong). It is treated with medication and careful oxygen/ventilation support.
There is another condition called a pleural effusion where fluid can build up in the space outside of the lung itself, and this can be drawn off with a needle. I'm not sure of the prevalence of that with covid-19
Thanks for answering.
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