Darren Markland

It’s what we like to call the, “do no harm phase.” This is where we try to find the balance of getting enough air in the patient so they don’t suffocate while trying not to tear up their stiff lungs and start the inflammation up again. If this were a joint you wouldn’t move it.

But that’s not an option, unless your a candidate for ECMO, which is where we put the patient on a lung bypass circuit. Oxygen and CO2 exchange outside the body via garden hose size cannula placed in the neck and groin. It’s pretty exceptional, & we can only do about 12 @ a time.

In the non ECMO pathway, we take it day by day. Our job is to protect the vulnerable patient from other things. Blood clots, bacterial infections, skin break down, kidney failure, malnutrition while we wait for the lungs to heal. It can take weeks.

Ok, now take a deep breath, all the way. Trust me. Just do it. Now hold it. That’s your new starting point. I want you to take your next breath from there. And your next. Don’t cheat. Pretty anxiety provoking, right?

To keep people with this lung disease (it’s call ARDS) from ripping their lungs apart we need to sedate them very heavily. Sometimes even paralyze them. It can make people incredibly weak, but there are no other options.

No for weeks we wait. Waiting for the lungs to heal. To relax. There is no clear way to predict who will get better and when. It’s an unclear pathway dictated by genetics and immunity. It’s heralded by the ventilators silence as it can relax and not push the air so hard.

At that point we can start to wake our patients up. There emergence is often dramatic, like coming up from deep water. We need to be gentle. Too much struggling and we can lose all of our gains.

I’ve seen some get better quickly. They act like good old bacterial pneumonia. Others take longer. We talk to families about tracheostomies and long term ventilation. They make progress but they will have long term complications from their journey.