Late one recent night, I found myself on the phone with my patient’s brother, trying to explain respiratory failure and COVID-19, the disease caused by the new coronavirus. He had been unable to sleep, he told me, after hours spent online in a futile attempt to understand what might be happening in his sister’s room in our hospital’s intensive care unit.
To try to minimize further damage, we select settings on the ventilator that deliver small breaths rather than large ones. Research shows that these small breaths can save lives in ARDS. Although these small breaths can be lifesaving, they are uncomfortable for patients who are awake. As a result, patients with ARDS are often deeply sedated in the early hours and days of their illness so that they are able to tolerate the ventilator.
For some patients, particularly those who were healthy before, this makes sense. For others, who might be older or more infirm with other health problems, a trach might not be within their goals of care.
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