Life After a Ventilator

If you cannot breathe on your own because infection or injury has caused your lungs to fail, you may need a ventilator.

A ventilator is a medical device that provides oxygen through a breathing tube to the lungs, taking over the body’s breathing process. This gives the patient time to heal and recover from serious illness.

“There are two groups of patients who end up with mechanical ventilation. The majority are on a ventilator for an average of four or five days,” says UNC pulmonologist and critical care doctor Thomas Bice, MD. “The second group is people who require it for 10 to 14 days or more.”

This second group of patients often have severe acute respiratory distress syndrome (ARDS), which occurs when fluid builds up in the lungs and prevents them from filling with enough air. Breathing becomes difficult and oxygen cannot get to vital organs.

People with coronavirus disease 2019 (COVID-19) who end up in the hospital ICU often fall into this second category. “Those patients tend to have a longer course of mechanical ventilation,” Dr. Bice says. “So this is a disease that seems to take a longer time to recover from.”

Side Effects of Mechanical Ventilation

Time on a ventilator can have lasting effects on a person’s mind and body for weeks and even months after leaving the hospital. This is called post-intensive care syndrome, and it can include physical weakness and cognitive dysfunction, sometimes called brain fog, marked by a loss of intellectual functions such as thinking, memory and reasoning. Patients with cognitive dysfunction have trouble recalling words, performing basic math and concentrating.

These thinking problems are caused by the medications needed to sedate patients while they are on the ventilators, Dr. Bice says.

There is also a high rate of PTSD in those patients and their caregivers. Symptoms include nightmares and unwanted memories about their stay in the ICU. About 35 percent have anxiety, and about 30 percent experience depression.

However, the extent of the side effects from being on a ventilator vary from person to person, and data on exactly how patients fare long term is limited.

“The world of post-intensive care syndrome follow-up and evaluation is relatively new, and so there’s not a ton yet that’s known,” Dr. Bice says. “It’s good news in that we in the ICU are getting better at helping people survive, but it takes time to do that longer-term follow-up to determine all of the issues.”

Time on Ventilator Drives Recovery Time

This much doctors know for sure: The longer you’re on a ventilator, the longer it will take for you to recover.

“The rule of thumb is that we expect people won’t feel back to 100 percent for at least a week for every day they spend on a ventilator,” Dr. Bice says. “If you’re spending four to five days on a ventilator, we expect it’s going to be four to five weeks before you’re really feeling back to your normal self.”

Keep in mind you will need assistance for weeks to months after leaving the hospital. You may not be able to walk or perform daily functions such as showering or cooking for yourself.

“The year after a prolonged ICU stay, most patients require some degree of care and assistance,” Dr. Bice says. “That degree of dependence varies among patients.”

Up to 50 percent of patients may return to work within the first year, but some may not be able to return to the jobs they had before their illness.

The Role of Family When a Loved One Is in the ICU

If you are a family member of someone in the ICU, there are steps you can take to help minimize the cognitive challenges your loved one may experience. It can be useful to talk about what day or date it is, and what time it is—just share the information; don’t quiz him or her. Bring photographs from home and talk about familiar people, pets, places and past events. You also can read aloud.

Consider keeping a bedside journal so you can stay on top of what is happening when. This can help reduce stress, because your loved one won’t feel pressure to remember. Also, ask a nurse or therapist to show you exercises that keep the patient’s body active; this is good for the brain, too.

Ask for help from the experts: ICU nurses and therapists can connect you with the resources you’ll need to help your loved one begin the journey to recovery once he or she leaves the hospital.

For the latest information on COVID-19, visit the CDC website and the UNC Health COVID-19 Resources page, and follow UNC Health on Twitter, Facebook, Instagram and YouTube.