Ventilator: A Life-Saving Sanjeevini, or Just a Way to Postpone Death?

This article first appeared in Kannada in ಕ್ಷ ಕಿರಣ, Dr Shashikiran Umakanth’s column in the Vishwavani daily. The Inside Story is its English edition. ಈ ಲೇಖನವನ್ನು ಕನ್ನಡದಲ್ಲಿ ಓದಿ

Anyone who has stood outside a hospital ICU knows the fear that settles in the chest while waiting there. The door opens, a doctor comes out and says, “He is finding it very hard to breathe. We may have to put him on a ventilator.” And I know exactly the first thought that runs through the family’s mind.

“A ventilator? Then the story is over! They only want to keep the body here and run up the bill. This is the hospital’s plan.”

As a doctor, I understand this fear and this suspicion. Some of the stories we have all heard about hospitals have taught us to think this way. But much of what we believe about this machine is simply not true. So let us sit down and clear the air.

This Is Not a Table Fan!

First of all, a ventilator is not a table fan that you switch on at home when the afternoon turns sticky! It is a highly complex machine. When the lungs are completely exhausted, it takes over their work: it pushes oxygen into the body and carries the poisonous carbon dioxide out.

Nor is it simply blowing air. The pressure of the air, the concentration of oxygen, the ratio of breathing in to breathing out… dozens of such settings have to be adjusted by the doctors, again and again, as the patient’s condition changes.

The Home UPS and the Ventilator

To understand what a ventilator really does, let us take an example everyone knows: the UPS, or inverter, at home.

We keep a UPS so that the house does not go dark the moment the power goes. When the main supply is cut, its job is to keep the lights burning until the current comes back.

Now think of the body as a house, and the lungs as its main power connection. In severe pneumonia, in dengue, or in sepsis, an infection that has spread through the whole body, the lungs stop working, or struggle to keep going. At that moment, the “UPS” the doctors reach for is called the ventilator! Until the medicines given for the illness begin to work and the lungs recover (until, that is, the current comes back), the machine holds on to the patient’s breath, and to the patient’s life.

When Does It Only Postpone Death?

Then where did the saying come from, that “a ventilator only postpones death”?

Back to our UPS. Suppose the main switchboard of the house has burnt out completely, or the house itself is about to collapse. How long can the UPS keep the lights on? Only until its battery runs down, surely? Here the UPS can only put off the darkness for a little while. It cannot give light for ever.

The One Big Misconception

“Once they put someone on a ventilator, it’s over… nobody comes back!” This is a plain untruth. Every day, hundreds of patients overcome serious illnesses with the help of a ventilator, recover completely, and go home.

What Should You Do?

It is wrong to say that doctors put patients on this machine only to make a bill. In most hospitals, the ICU team weighs the patient’s condition carefully and scientifically before it takes this decision.

Understand the reality, talk openly with the doctors, and decide together. That is the wise course.