The current wave of COVID cases is leading to more hospital and intensive care (ICU) admissions. Frontline health workers and specialists use the term “intubation” to refer to the additional breathing support some patients require in an emergency.
But many people do not know what is involved in the process and what trauma it can cause.
Patients with COVID-19 whose condition worsens and require additional assistance with breathing require intubating and ventilating. This means that a tube is inserted and a ventilation machine delivers oxygen directly to the lungs.
Intubating a patient is a highly efficient procedure and involves inserting a tube through the patient’s mouth and into their airway:
Patients are usually sedated, allowing their mouth and airway to rest. They often lie on their back while the health care professional stands near the top of the bed with the patient’s legs facing up.
The patient’s mouth is gently opened. An instrument called a laryngoscope is used to flatten the tongue and illuminate the throat. The tube is passed down the throat and further into the airway, separating the vocal cords.
A small balloon is inflated around the tube to hold the tube in place and prevent air from escaping. Once this balloon is inflated, the tube should be tied or taped in place in the mouth.
Successful placement is checked by listening to the lungs with a stethoscope and confirmed via chest X-ray.
Read more: How are the most serious COVID-19 cases treated, and does the coronavirus cause permanent damage?
Can’t breathe, can’t speak, or swallow
While intubated patients are attached to a ventilator and their breathing is supported, they are unable to talk or swallow food, drink or their own saliva.
They are often unconscious enough to be able to bear the tube. They cannot meet any of their needs and disconnection from the ventilator can be disastrous.
For this reason any patient who is intubated and ventilated is cared for in an intensive care unit, with a registered nurse constantly by their bedside.
American lawyer and editor David Lett recalls his experience of being intubated and ventilated after being diagnosed with COVID-19:
When they were giving me anesthesia to put me to sleep so they could put a tube in my mouth so I could breathe, I just remembered thinking, ‘I might die.’ Sometimes in essence, you think, ‘If it’s my time, then it’s my time.’ but when i was at that table […] I just thought, ‘No, I don’t want to go.’
Lett feared that he would never see his two-year-old son or his partner again.
take out tube
A COVID patient requires intubation and ventilation depending on the cause and response to treatment. However, there are reports of patients being intubated and ventilated for more than 100 days.
Once a patient’s respiration improves and they no longer need breathing support, the tube is removed in a process called “extubation.” Like intubation, removal requires highly skilled health care personnel to manage the procedure. Contains:
A spontaneous breathing test, which assesses the patient’s ability to breathe to reduce the risk of respiratory failure.
Assessment of the patient’s ability to cough by the treating doctor, intensive care nurse, speech pathologist or physiotherapist (so that they can effectively clear their throat and prevent substances from entering the lungs)
If the patient has had mechanical ventilation for more than 48 hours, treatment with a physiotherapist is usually required before and after extubation. This is to ease the process of weaning the patient off the ventilator and helping them to breathe freely again.
Once evacuated, patients remain in the ICU and are closely monitored to ensure that they can safely maintain a clear and effective airway. Once they are able to do so and are stable enough to be transferred to the ward, they are discharged from the ICU.
Intubation, ICU and trauma
Patients with COVID-19 requiring intubation and ventilation have seen many stressful events in the ICU, such as emergency resuscitation procedures and deaths. This can increase the risk of post-traumatic stress disorder, anxiety and depression.
Although we do not have definitive long-term data, patients who are critically ill with COVID often have a long and difficult journey to recovery. They will likely be dependent on health care services for some time.
Many patients who have been intubated and ventilated remember it as one of the worst experiences of their lives. Clearly this is something we should try to avoid as many people as possible.
There in present 138 patients were intubated and ventilated in ICUs across Australia. That’s 138 patients who can’t communicate with their loved ones, who are scared, frightened and vulnerable.
Most of these patients have not been vaccinated. The most important thing we can do to reduce the risk of being intubated and ventilated as a result of COVID-19 is vaccination.
Read more: We are two frontline COVID doctors. Here we see that the case numbers increase