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Ventilators are typically used only when patients are extremely ill, so experts believe that between 40% and 50% of patients die after going on ventilation, regardless of the underlying illness.
These critically ill patients die because they are so sick from COVID-19 that they needed a ventilator to remain alive, not because the ventilator fatally harms them, said Dr. Hassan Khouli, chair of critical care medicine at the Cleveland Clinic in Ohio.
“I think for the most part it’s not related to the ventilator,” Khouli said. “They’re dying on the ventilator and not necessarily dying because of being on a ventilator.”
An 88% death rate is especially high, however.
Ventilators do have side effects. Because a machine is breathing for them, patients often experience a weakening of their diaphragm and all the other muscles involved with drawing breath, Chaddha said.
“When all these muscles become weaker, it becomes more difficult for you to breathe on your own when you’re ready to be liberated from the ventilator,” Chaddha said.
These patients also are at risk of ventilator-associated acute lung injury, a condition caused by overinflating the lungs during mechanical ventilation, Khouli said.
Doctors have to precisely calculate the amount of air to push into a person’s lungs with every mechanical breath, taking into account the fact that a large part of the lung could be full of fluid and incapable of inflation. “The amount of volume you need to deliver would be usually less,” he said.
“If the settings are not managed correctly, it can cause an additional trauma to the lungs,” Khouli said.
Ventilated patients also are at increased risk of infection, and many are at risk of psychological complications, Chaddha said. A quarter develop post-traumatic stress disorder, and as many as half might suffer subsequent depression.
“It is not a benign thing,” Chaddha said. “There are a lot of side effects. And the longer they are on a ventilator, the more likely these complications are to happen.”
Besides the statistics on ventilated patients, the New York study also pointed to several factors that contribute to more severe illness in COVID-19 patients.
