New Scientist - USA (2021-02-13)

13 February 2021 | New Scientist | 43

Placing people on

their fronts allows

oxygen to reach

more of the lungs

The view from intensive care

Fears about ventilators are costing people their lives, 

Alison Pittard tells Tiffany O’Callaghan

As an anaesthetist and intensive

care specialist, Alison Pittard has

been on the front lines of the covid-19

pandemic, which she says has forced

her profession to rapidly adapt how

they develop new practices. As well

as concern about burnout and moral

injury among her colleagues, she

worries that misconceptions about

intensive care are driving people to

turn down life-saving treatment.

Tiffany O’Callaghan: How do

you decide if someone needs

a ventilator?

Alison Pittard: We take each patient

as an individual, look at their blood

oxygen levels, their respiratory rate,

how tired they are, whether it’s

becoming difficult for them to

breathe, how distressed they are.

We have several non-invasive

modes of ventilation, including kinds

that help to support breathing by

providing a little bit of pressure to help

keep the lungs open, rather than just

supplemental oxygen, so you don’t

have to work quite as hard to get

that big breath.

If these are not enough or if the

patient is becoming really distressed,

then we would sedate them and insert

a tube down into their windpipe and

use a ventilator.

Are you able to talk

patients through this?

I think people often get the impression

that in intensive care everything is

rushed and there are emergencies

going on all the time. And it can be

like that. But certainly for these types

of patients, we’re watching them

very, very carefully and closely and

can start to see when they are getting

tired, that they’re heading towards

needing to be ventilated.

We are speaking to patients all the

time, so we can say to them, “This

is what we’re planning on doing. It

doesn’t look like you’re managing very

well.” They can often see that they’re

struggling, they’re getting tired. It’s

very frightening for them. But you can

have that conversation and explain

what we’re going to need to do.

Usually, we can see a steady

deterioration and it becomes fairly

obvious to us that the only option

available is to sedate the patient and

put them on a ventilator, because

without it they would die.

How difficult are

those conversations?

One thing we’re finding in intensive

care is that people are really scared of

being sedated and ventilated because

they think that it kills people. That’s not

the case. The disease kills you.

It’s really difficult for staff when you

can see a patient in front of you who

desperately needs to be sedated and

ventilated, but they refuse. They would

rather just try and avoid it and they are

adamant. And we know that if we

can’t do that then they’re going to die.

My plea is for people to put their

trust in us. Allow us to share our

knowledge and experience. Take our

advice. We don’t want to see people

die unnecessarily, and if we know that

sedating and ventilating somebody

gives them a chance of survival, that

has to be better than no chance. We

only ever want to make people better.

Es

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2020

Beginning of

the second

wave

0

10

20

30

40

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MarAprMayJun Jul AugSeptOctNovDec

Reducing deaths
Treatment changes have cut the number of people
who die in critical care in England after having had
covid-19 for 28 days, but some of those gains
were eroded when a second wave of infections
swamped hospitals

SOURCE: INTENSIVE CARE NATIONAL AUDIT AND RESEARCH CENTRE

Alison Pittard

is dean of the

Faculty of

Intensive Care

Medicine

in the UK