Name:   CRD - Subject:   CRD’s input could help..... Date:   4/5/2020 8:41:39 AM

COVID19 is essentially leading to in severe cases,  what is known as ARDS, Acute Respiratory Distress Syndrome.  This condition has always been one that is a challenge to manage because of the need for, in many cases, long term respiratory support.  In order to maintain proper pulmonary toilet, a standard initial oral intubation is often followed by a tracheostomy.  Today's ventilators are indeed an engineering marvel.  They can breath for you, they can assist you while you are attempting to breath, they can apply pressure at the end of the expiratory cycle to keep portions of your lung alveoli open for further oxygenation, they can design an inspiratory and expiratory ventilation wave pattern, they can provide short bursts of ventilation among many other modalities.  There is protocol for weaning from a ventilator as medications are decreased that allow for more spontaneous effort which the ventilator will support, all to maintain approtpirate and physicologic oxygen levels. 

The longer that an individual is on a ventilator, the more risk that individual has for development of lung injury, where the lungs become too stiff (loss of compliance) to expand and the work of breathing becomes too excessive.  Think of a balloon.  The larger the balloon, the more difficult it is to blow air into it.  Then there is the risk of an actual bacterial pneumonia the longer one is intubated, caused by resistant bacteria in the hospital flora.  Those repiratory therapists and Intensivists that manage these cases are to be admired for the challenge they face in the ICU's today.  

I hope this helps!