The number one cause of stress related mucosal disease in the intensive care unit is the ventilator. But how does a ventilator attached to a lung cause bleeding in the stomach? Because the ventilator forces air under pressure into an organ that is literally 80% air by volume and in the process damages the lung’s incredibly delicate structures. This then causes inflammation. The mediators of that inflammation then leave the lung, traveling in the blood to the stomach causing dysregulation of blood perfusion to its capillary beds. This then causes a reperfusion injury that results in shutting off prostaglandin production, causing cessation of bicarbonate rich mucous production that normally lines the stomach protecting it from its acid. This results in erosions of the stomach lining and bleeding.
Oh my. All this from a ventilator?
Now imagine a lung disease of intense inflammation but near normal compliance - Covid 19. Those lungs would be orders of magnitude more susceptible to the harm ventilators can cause than normal lungs or really any lungs we have ever encountered in the intensive care unit before.
What a unique, deadly, disease. We have never seen anything quite like it. We have been learning while doing. But as it turns out the answer to Covid 19, once a patient has reached the ICU and needs a breathing machine, may be as simple as not using breathing machines. That’s right, instead of putting people on ventilators put them on a machine that does the work of the lung without damaging it, providing an opportunity to rest a ‘sprained’ injured lung, much as we would rest twisted ankles, until the lung has had a chance to heal. Use V/V ECMO.
Sounds simple enough. But you would think I was suggesting no longer bleeding patients to 17th century Europe. Or refusing to ask patients to inhale mercury vapors in order to treat the pox (syphylis) in the 15th century. Sacrilege.
It’s new. It’s different. It competes for resources with other fields of medicine that traditionally don't play well with others. But mostly the idea diminishes the role of the cornerstone of the intensive care unit since its inception - the ventilator.
Tough. It’s the right thing to do. It will save lives.
Oh my. All this from a ventilator?
Now imagine a lung disease of intense inflammation but near normal compliance - Covid 19. Those lungs would be orders of magnitude more susceptible to the harm ventilators can cause than normal lungs or really any lungs we have ever encountered in the intensive care unit before.
What a unique, deadly, disease. We have never seen anything quite like it. We have been learning while doing. But as it turns out the answer to Covid 19, once a patient has reached the ICU and needs a breathing machine, may be as simple as not using breathing machines. That’s right, instead of putting people on ventilators put them on a machine that does the work of the lung without damaging it, providing an opportunity to rest a ‘sprained’ injured lung, much as we would rest twisted ankles, until the lung has had a chance to heal. Use V/V ECMO.
Sounds simple enough. But you would think I was suggesting no longer bleeding patients to 17th century Europe. Or refusing to ask patients to inhale mercury vapors in order to treat the pox (syphylis) in the 15th century. Sacrilege.
It’s new. It’s different. It competes for resources with other fields of medicine that traditionally don't play well with others. But mostly the idea diminishes the role of the cornerstone of the intensive care unit since its inception - the ventilator.
Tough. It’s the right thing to do. It will save lives.
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