Do Not Ever Intubate Me if I Get Covid

One year ago, if we had patients with sats in the mid to low 80s who were receiving 100% FiO2s, we'd probably seriously think about intubating. 

COVID changed this. Maybe even for the better, actually. So many times I thought we intubated a person because we didn't give them a chance to turn around. So many times we intubated someone just because they had sats that were low. Like, we never really gave them a chance to turn around. We just intubated.

And this was for good reason. People need oxygen to survive. So, when COVID-19 started making its way around the globe, the initial instinct was to intubate those we were unable to oxygenate. But most of these people died. 

We learned that positive pressures somehow damage the lungs already damaged by COVID-19. COVID makes lungs stiff. It causes pulmonary fibrosis. So, constantly pounding on these lungs with positive pressures further damages them. It creates a type of damage that a person cannot survive.

I have to do more reading on what actually happens with severe COVID. I have heard that blood clots form, and these cause small PEs inside the lungs. These increase the likelihood of pneumothorax. These clots get into your blood and impact your brain. They cause strokes. 

And I have seen a few people survive being ventilated. But 100% of those patients continued to have complications. They all required long-term rehabilitation. And even then, I have no idea if any of them ever returned home. They had strokes. They had so many other complications due to COVID. 

I have not done a lot of research on the long-term prospects of anyone who requires BiPAP or ventilators for COVID. I do not have faith. 

Most of those who require 100% FiO2 take a long time to recover. Almost everyone is in a room for months. If they do recover, it is slow. If they do not recover, it is slow. Some make the decision to go to hospice. Others make the decision to live and go on a ventilator. 

A doctor explained it well to me. He said COVID patients who require a ventilator are going to die. They are all in the process of dying. So, we have to be honest with them and their families. They get to make two choices. They can either continue on as they are, on high flow and a nonrebreather to maintain their oxygen level. They can continue to talk to their family and friends. They can continue to be aware.

The hope here is that they eventually turn around and get better. But, if they get worse, if they feel short of breath and panicky, we can treat that with pain medicine and sedatives. We can take the edge off so you don't suffer. 

The other path is to prolong your life with a ventilator. This will require deep sedation. You will not be aware of what is going on. You will not be able to talk to your friends and family. And, the odds are that you will be on a ventilator a long time, with a very low chance of ever coming off. If you do come off, you will require long-term rehabilitation. 

Well, you will require long-term rehabilitation either way. You have severe COVID, you cannot hardly move without your oxygen level dropping. When it drops, healthcare workers want you to lie on your belly. For some reason, this helps your lungs oxygenate better. But it is uncomfortable lying on your belly all day. Most people hate it. So, sedation can help here too.

My point is that, if you get severe COVID, you can't hardly move. You cannot get out of bed. This causes your muscles to get flaccid. You get weak and fatigued. You will require months of rehabilitation. And that is IF you survive. 

So, my coworkers and I have all decided we do not want to be put on ventilators if we get COVID-19. We have all decided we would rather stay on the 100% oxygen route and hope for the best. If we continue to trend downward, we want comfort care. 

So, if I get COVID-19, do not ever intubate me. What about you? What are your thoughts about ventilators and COVID? Let us know in the comments below.