Kent doctor explains purpose, importance of ventilators

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“The body works as a family,” Dr. Ehsun R. Mirza says, and when one organ of the body comes under attack, “it puts stress on all the family members.”

The lungs, which bring oxygen to our blood cells that feed other members of the family body and expel carbon dioxide, are most frequently the first organs to come under attack by COVID-19.

“Viral pneumonia” is the biggest issue with who gets the virus by causing lack of oxygen to the body,” he said.

The heart and kidneys are also primary targets of the virus, said Mirza. Yet, he said – and this is what makes it so difficult to track down and isolate those with COVID – about 80 percent of those with the disease show no signs of it. Furthermore, COVID is highly infectious, so the disease is not only a hidden intruder among us but also aggressively seeking new hosts.

With COVID compromising the function of the lungs, pneumonia is the big killer of those who get the virus. Fortunately, the medical community has developed weapons to fight back – and in the battle against coronavirus, the ventilator is on the front line. It is the machine being rushed into production. Also, it is a device an MIT team, according to a report by ABC News, is looking to simplify so it can be rapidly manufactured at a fraction of the $35,000 they usually cost.

Gov. Gina Raimondo wants more ventilators in anticipation of a surge of COVID-19 patients in the next couple of weeks. Simply put, the ventilator assists the lungs. Whether designed with bellows, pistons and more commonly today a turbopump, the ventilator pumps a mixture of air and oxygen either through a mask fitted over the face or a tube fed down the throat and into the trachea. The pressure of the air mixture can be adjusted to meet the patient’s need. When it is released, as the case when you exhale naturally, the lungs compress to expel carbon dioxide through a one-way valve.

Mirza said a patient’s condition determines to what extent a ventilator assists or, in extreme cases, takes over for the breathing process. Patients can be fully conscious with the ventilator augmenting the natural intake of air. In other cases, the patient may be lightly sedated or fully sedated.

“There are certain patients who are so sick, we don’t allow them to basically breathe [on their own],” Mirza said.

Mirza, who was born, raised and educated in Karachi, Pakistan, did his residency at the Harrisburg Hospital in Pennsylvania followed by fellowships in renal and critical care medicine from Brown University. Mirza has been working as an intensivist in the ICU at Kent Hospital since 2003.

He and his wife, Dr. Saira Hussain, are the parents of three children. Mirza is a painter, photographer and a yogi. He frequently goes back to Pakistan for medical camps and other volunteer services.

Ventilators are not without drawbacks. They can be invasive and traumatic, and some patients and their families ask that they not be used even if they could be life-prolonging.

If in short supply, could a ventilator be used by more than one patient? Could, for example, a ventilator be used for an hour by one patient, switched to another for another hour and then back to the first?

Mirza said that doesn’t work, and generally once on a ventilator, a patient is kept on that machine until they are capable of breathing on their own. On average, that takes a period of 10 days. That complicates ventilator deployment when there are multiple patients who could benefit and a limited number of machines.

In other parts of the country, doctors are faced with the issue of who gets to use a ventilator when there aren’t enough for everyone. Doctors hope that won’t happen here, but it’s one aspect of what makes a massive surge so frightening.

Mirza says “we’re still in the safe zone” where the medical community can address patient needs, and if Rhode Islanders continue doing those things to prevent the spread of the disease, “we might not have a massive surge.”

He said “it is extremely important” that Rhode Islanders follow the governor’s directives on limiting physical contact with one another, follow protocols to stop the spread of the virus and protect themselves and others by distancing and wearing masks.

“Stay home,” Mirza said.

To emphasize the severity of the situation, Mirza adds, “these numbers [positive cases and deaths] are not fake.”

Mirza is in awe of the team he works with and the larger community support he’s seen. Health care providers are selflessly putting in long hours and exposing themselves to help others.

“I see no one grumbling,” he said. And while he understands people are afraid, “no one is stepping back.”

He is also heartened by the community response and support – the delivery of pizza, cookies and hot meals to the hospital, the making of masks by individuals and groups, and the demonstrations of support such as the drive-by at Kent Hospital Tuesday night by police vehicles and fire apparatus from municipalities served by Kent.

“I am so privileged and honored to be a part of this community,” he said.

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