Royal Columbian Hospital to study best use of ventilators on COVID-19 patients

Mechanical ventilators have been key to saving the lives of COVID-19 patients around the world and in B.C. a leading medical expert hopes to find how these machines can save even more.

Dr. Steve Reynolds, medical director and critical care and infectious diseases specialist at New Westminster's Royal Columbian Hospital, will launch this week what the hospital foundation is calling a first-ever study to collect data from COVID-19 patients on ventilators at the hospital.

The hope is the study could lead to new ideas about how best to use ventilators on COVID-19 patients.

"It's a really key aspect," Reynolds told reporters over streaming video. "I think people have heard a lot about ventilator shortages but it's really key how … you deliver this mechanical ventilation.

"We can contribute to the global discussion on this."

The lab, he said, has diagnostic tools that can provide real-time data about how different approaches to ventilator use, especially when it comes to ventilator pressure, impact patient outcomes.

The hope is to rapidly share this information with researchers around the world and patients' doctors to develop new approaches for ventilator use.

COVID-19 lungs may be different

Reynolds said doctors are finding COVID-19 patients' lungs may behave somewhat differently than lungs afflicted with other diseases.

Viral pneumonia or a lung infection usually leads to "stiff" lungs, he explained, and ventilators treating those diseases use high pressure to keep the lungs open and minimize injury.

COVID-19 lungs may look the same in some ways, Reynolds said, even from X-Ray pictures but new thinking holds they might not need as much pressure.

"We expect the lungs, when they're inflamed and injured, to act a certain way and there's indications that [COVID-19 patients' lungs] actually act differently," he said.

"Our regular way we manage these patients may not be optimal."

Too much ventilator pressure can cause injury, especially with inflamed lungs, Reynolds said. It can also damage the heart and kidneys.

The lab at Royal Columbian can look inside the lungs non-invasively, he said, to monitor how different pressures lead to different responses from the lungs of these patients and how the pressure changes can impact other organs.

B.C. in unique position

The study will be exploring new ideas about ventilator pressure out of Italy that first suggested lower pressure may be better.

Reynolds said doctors in B.C. are uniquely positioned to help with research efforts.

He says thanks to a combination of luck, good leadership, compliance and help from the population, the province's hospitals have a relative handle on the pandemic locally and the resources are there for research.

"This is a disaster for folks across the world," Reynolds said. "This is a way we can contribute to the global conversation and improve outcomes beyond just what we see in front of us."

Reynolds said the study will start with 10 patients coming to Royal Columbian. The hospital is one of the three primary COVID-19 treatment sites in the Fraser Health region.

Researchers will look into how those patients respond when put onto mechanical ventilation and how they can best be managed.

Then, the researchers hope to log how their conditions change over time and develop hypotheses for wider study.