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Comment by theamk | Hacker News Reader

This seems pretty important:

> While the standard for a conventional ventilator uses a mask or nose tubes and follows current guidelines, the pandemic ventilator is at a standard from the 1970s and requires a patient be intubated, the medical word used to describe putting a tube through someone's mouth and into their airway.

Do intubated patients need more attention from nurses/doctors? It certainly sounds harder then putting on the mask.

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Yes. You need usually an ED physician or CCU physician. We get taught how to do it in medical school, but that doesn't mean we're proficient. You need an ICU nurse level of skill to monitor the vent and it's an intense process. There are some drugs you can give to attenuate oral and esophageal secretions. Usually there's a significant amount of suctioning involved.

How it compares to managing a mask day to day? I honestly don't know, that's something an ICU nurse/respiratory therapist would know.

Yes. Without proper cleaning, it is a highway for infection. You also need to maintain a balance of blood oxygen and carbon dioxide. Many of these people require supplemental oxygen. So, you have to control respiration rate and oxygen mix. This would be a very bad to try yourself.

Intubation also reduces risk of of the patient infecting others.

Harder to infect others if you’re dead.

Unless you plan ahead ;)

One of the other big issues hitting during this crisis beyond simple availability of ventilation machines is the number of nurses and doctors available to monitor and care for patients when they have to go to the ICU. Ideally the machine would be both cheap and easy to produce and require less qualified monitoring.

If we get way more machines but those machines require a lot of intensive monitoring we could wind up with plenty of machines but not making any progress on the fatality rate.

Do intubated patients have to be sedated/anesthetized?

Very important question, surprised it hasn’t been asked. Yes they do, the gag reflex is very strong. Source, wife is a nurse.

IANAD, but my understanding is that minimal sedation leads to better outcomes, so patients may be partially awake some of the time, varying the dose of propofol and fentanyl. During these low-sedation times they may do breathing trials to try to wean off the ventilator. (They called this "sedation vacation" in the ICU I visited.) Not sure if this is how COVID victims will be treated, though.

All COVID-19 patients are intubated to control aerosol creation.

That sounds extreme. Do you have a citation?

Not the op and I don't have a source available but I read the same earlier this week (can't find out were though :/)

That is not true. Some are intubated if the mask respirators fail to provide proper oxygenation, but it is by no means the default.

Source: my sister is a nurse at a hospital treating dozens of COVID-19 patients.

Sorry, I ment for ventilation. This is from a report in one hospital and it's possible other controls are being used.

We are all rooting for your sister.

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