“If you have an infection, your body tries to recruit as many immune cells as it can to fight that infection,’’ he says. “While it is effective at destroying the cells that have the virus, it has the potential to damage the surrounding tissue as well.’’
The interplay between the respiratory and circulatory systems, which run oxygen-enriched blood through the body, is delicate. In Covid-19 patients, the lungs don’t move enough oxygen. This restricts the amount that makes it into the blood, where it is supposed to fuel the body, repair and replace damaged cells and support the immune system.
That’s where a ventilator comes in.
It can be adjusted to boost oxygen, pressure and volume, pushing the air more forcefully into the lungs. But even when a patient is severely ill, some alveoli still function well. The goal is to take the pressure off the sick regions while supporting those that are still working, making sure they have the ideal amounts of oxygen and pressure so they can enrich the blood as efficiently as possible.
“I call this the Goldilocks approach,’’ says J. Brady Scott, an associate professor of cardiopulmonary sciences at Rush University Medical Center in Chicago. “When we put people on ventilators, one of my goals is to give a person the oxygen they need but not cause damage to the parts of the lungs that are still healthy. You don’t want to get too little, not too much. You want to give just what’s right.’’
Though weak, Diana felt a wave of euphoria when she was free of the ventilator. But her sense of joy was short-lived. A doctor informed her that her husband was on life support in the ICU room next to hers. Diana was crushed. Had she made it this far, only to see her husband of 35 years taken away from her? The couple had been together since Diana was just 17 years old. She wasn’t about to say goodbye to him now. The following day, as she was wheeled out of intensive care, her nurse pulled her bed up beside his room to let her peer through the glass window so she could catch a glimpse of Carlos, who was now on a ventilator, too.
“I don’t know how I pulled my body to sit up, but I wanted to see him,” she says. Her cell phone felt like a brick in her weak hand, but Aguilar managed to lift it above the bed frame to snap a photo of Carlos. She blessed him before she was whisked away, exhausted.
With both parents in intensive care, the Aguilar’s grown children were distraught. Carlos Aguilar Jr., 32, lives with his parents in New Jersey and had watched them both rapidly deteriorate from Covid-19 at home. “I felt helpless,’’ he says, especially after dropping his dad off at the hospital, waiting in the silent house for a phone call. “Not knowing what’s next is so hard.”
For years, the main focus of critical-care doctors who intubate patients has been keeping them alive, fine-tuning the treatments in an effort to improve survival rates. The machines, first introduced in 1928, were initially called iron lungs and used to help polio patients breathe. Only recently have researchers learned that the biological responses to the breathing machines that kick in almost immediately often have lasting harm.
“There are a lot of other dangers when we use mechanical ventilation,’’ says Richard Lee, interim chief of pulmonary diseases and critical-care medicine at the University of California at Irvine. “We have to sedate patients for them to tolerate a mechanical breathing tube in their lungs, and the longer you are in an ICU on sedation requiring a machine, all those other things — like decreased muscle tone and strength and the risk of hospital-acquired infections — increase.’’