Some hospitals have a dedicated rotating bed for this; at mine, our nurses gently roll the patient over. This works by changing how blood flows through the lungs, so it doesn’t pool with gravity in the collapsed bottom of the lungs. Though it might sound odd, researchers have studied prone positioning and found that it reduces mortality in severe lung failure.
And if that isn’t enough?
Your doctors might talk about something called extracorporeal membrane oxygenation, or ECMO. This is essentially a lung bypass machine.
I mention ECMO with caution. While we are newly facing the reality that ventilators are a limited resource, ECMO is far scarcer — some hospitals don’t have any machines at all, while others have a handful at most. And even if there were unlimited machines, ECMO is far from a panacea. It comes with significant risk, including stroke and catastrophic bleeding; however, in very specific cases, it might be the best way to support someone while their lungs heal. If your doctors think ECMO is the next best move, they will talk with the patient’s family members about the risks and benefits before they would go forward.
What else are doctors monitoring in the I.C.U.?
We monitor the function of every organ at least once a day, and often more frequently than that. Our goal is to make sure that to whatever extent possible, we keep the rest of the organs healthy while the lungs recover — with a particularly careful eye to the heart and kidneys. We also monitor for signs of a new infection and, if we suspect one, we treat quickly and aggressively with antibiotics.
Will there be long-term lung damage?
Covid-19 is new. We don’t yet have long-term studies of survivors; however, based on the experience of other survivors with ARDS, we do know that recovery is possible, but it will take a long time, as long as months to years. We also understand that ARDS survivors can face a constellation of issues — anxiety, depression, post-traumatic stress, even cognitive dysfunction — after they recover from their critical illness. As we see more survivors of ARDS from Covid-19, these are questions and issues that we as doctors will need to address.
What if doctors can’t get a patient off the vent?
Sometimes, when improvement is slow and someone has been on the ventilator for two weeks or so, we talk to family members about a procedure called a tracheostomy tube, a plastic tube in the neck that offers a more permanent connection to the ventilator. The breathing tube itself can do damage to the vocal cords if left in for more than about two weeks, so the tracheostomy, or “trach,” allows more time for the lungs to recover, while avoiding damage to the vocal cords. Often this period of recovery also requires a transfer to a facility called a long-term acute care hospital.
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.