Why Ventilators May Not Be Working as Well for COVID-19 Patients As Doctors Hoped

New York City emergency-medicine physician Dr. Cameron Kyle-Sidell sparked controversy when, two weeks ago, he posted a YouTube video claiming that ventilators may be harming COVID-19 patients more than they’re helping.

Mechanical ventilation always comes with risks: a tube must be placed into a patient’s airway to deliver oxygen to their body when their lungs no longer can. It’s an invasive form of support, and most doctors view it as a last resort. Under the best of circumstances, up to half of patients sick enough to require this type of ventilation won’t make it.

Story continuesBut Dr. David Hill, a pulmonary and critical care physician who treats COVID-19 patients in Waterbury, Conn., says arguments against COVID-19 ventilation have been over-simplified. It may be less that ventilators aren’t the proper treatment for coronavirus, and more that they’re not a panacea for a pandemic that has pushed the health care system to its breaking point, Hill argues.

Few doctors are saying COVID-19 patients should never be ventilated, but there is a growing subset that thinks it’s happening too quickly. Dr. Nicholas Hill , chief of pulmonary, critical care and sleep medicine at Tufts Medical Center in Boston and a past president of the American Thoracic Society, says he’s avoiding mechanical ventilation when he can, and finding success with some non-invasive options like flipping patients onto their stomachs, which can trigger better blood flow to the lungs.

Then there’s the issue of how to treat patients who do end up on ventilators. Tufts’ Hill agrees that COVID-19 patients do not behave exactly like they have ARDS, a type of respiratory distress that occurs when fluid builds up in the lungs’ air sacs. The lungs usually get stiff when a patient has ARDS, requiring high-pressure ventilation to support them.

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