To ventilate or not to ventilate: A qualitative analysis of physicians’ experience during the first and second waves of the COVID-19 pandemic

Little is known about experiences of physicians when deciding on initiating life support during medical crises of mass casualties and undersupply. We performed a qualitative analysis of interviews with 14 physicians about their decision-making experience when considering initiating mechanical ventilation in patients with severe COVID-19 during the early pandemic. Three themes were revealed: (a) The accumulating clinical experience with invasive ventilation, and the physicians' perception of ventilation as effective or futile in these patients; (b) Preferences of patients and their families regarding mechanical ventilation; and (c) Economic, logistic, and organizational considerations of the undersupplied healthcare system. The circumstances under which end-of-life decisions were made often caused moral injury to physicians, in particular when their personal ethical standpoints were not integrated in the decision-making process. Our findings explore the moral injury suffered by physicians and may help identify strategies to mitigate moral injury of healthcare staff in times of medical crisis.