Most ICUs have mechanical ventilation support, but only specialized ICUs at larger hospitals offer extra corporeal membrane oxygenation, or ECMO for short. ECMO is reserved for the sickest patients with respiratory failure when mechanical ventilation support, even with proning position, is insufficient to meet a patient's respiratory requirements. In ECMO, large catheters are inserted into a patient's central blood vessels. Blood is removed out of the body and oxygenated through a membrane that is outside of the body. Once oxygen is added and carbon dioxide is removed from the membrane, the blood is then returned back to the body. Again, it's uncommon for patients with COVID-19 to actually require ECMO and only certain centers have the expertise to offer this intervention. Mechanical ventilation is an invasive procedure which can cause discomfort for the patients. Patients needing mechanical ventilation are provided sedation and analgesic medications for comfort. In addition, artificial nutrition via a feeding tube inserted from the mouth to the stomach is also provided, as patients cannot naturally eat when they're on mechanical ventilation. Physical therapy is recommended for patients who are improving to help regain musculoskeletal strength. Supportive medications to prevent gastric bleeding and blood clots are also administered. The length of time patients with COVID-19 infections remain on mechanical ventilation is variable. Anecdotally speaking, patients usually remain on mechanical ventilation for over one week. In patients needing mechanical ventilation for over two weeks, a tracheotomy is considered to allow for more long-term ventilatory support.
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