This week, I attended a course designed to quickly reeducate nurses coming back to the critical care realm who have been gone awhile. It was fast-paced, intense, and eye-opening. There is a lot of information I had forgotten–I’ve been gone over 10 years–and some new things too. When I worked in the ICU before, I was a different person than who I am today, with a different, new set of life experiences and skills. And of course, critical care has changed a lot too.
As a part of our ventilator review, we each had to be placed on one for a few minutes. This scary exercise was to demonstrate what it’s like to be on the receiving end of life support. The prospect terrified me. Even though we did it through mouthpieces (not endotracheal tubes) and in a controlled environment, I worried I might panic, blow a lung, or have an asthma attack.
The respiratory therapist gave me the option of participating, given the problems I have with my lungs and heart. But I felt as though going through the experience would give me more empathy and understanding of people on these machines.
To call being on a ventilator a harrowing experience is putting it lightly. The therapist placed me on the “easiest” settings (which he did for everyone). Even the minimal dose of continous positive airway pressure (CPAP) was very uncomfortable. It felt as if air was being shoved down my throat. We progressed to pressure support, and I had to take a little break. The final demonstration was pressure control ventilation, set ridiculously low compared to what patients are prescribed. It was like walking outside into hurricane-force winds face-first. It was a blast that puffed my cheeks out forcefully and made my lips and fingers numb (hyperventilation, brought on by the ventilator). It certainly was an eye–and airway–opener!
I was prepared for this situation. The average non-medical person who gets pneumonia and is waking, confused, from sedation in the ICU will be caught completely off guard. To add to the terror, that person will have an endotracheal tube making him or her gag and feel like choking. No wonder these people try to grab their tubes and fight so hard–they panic! There is absolutely nothing normal about ventilator breaths, and even though the machine is helping you, it feels as though you cannot breathe.
This has shed new light on why people “freak out” as they do in the ICU, and might explain some of the psychosis, PTSD, and cognitive changes we sometimes see when people move out of intensive care. This experience will help me to communicate more effectively with patients and their families.