Ventilators are not a panacea
-
https://spectator.us/ventilators-arent-panacea-pandemic-coronavirus/
‘More ventilators!’ cried the journalists on Twitter. ‘Yes, more ventilators!’ replied the politicians. ‘Where are the ventilators?’ demanded the journalists, now screaming on television. ‘Yes, even more!’ replied the government, somewhat nonsensically.
I am a critical care physician, specializing in the use of such machines. I’m flattered by all the attention our tools are receiving. But I fear the current clamor reminds me of nothing so much as the panic buyers of toilet-paper stampeding over each other in early March. When the history of the COVID-19 pandemic in the Western world is written, I do not believe ‘massive ramp-up of ventilator manufacturing,’ will be credited with our deliverance. Let me explain why.
Ventilators do not cure any disease. They can fill your lungs with air when you find yourself unable to do so yourself. They are associated with lung diseases in the public’s consciousness, but this is not in fact their most common or most appropriate application....
When we mechanically blow air into your damaged lungs faster and harder than humanly possible, ventilator-induced lung injury may result. Generally, for a person to tolerate the undertaking, we have to sedate them, leading to immobility and severe weakness. While sedated, the person cannot cough or clear their airway effectively, leading to superimposed bacterial pneumonia.
This is an awful lot to survive. And in the case of COVID-19, the preliminary outcome data is rather dismal. On Monday, the New England Journal of Medicine published a case series of very ill COVID-19 patients in Seattle with data up to March 23: of the 20 patients who went on a ventilator, only four had so far escaped the hospital alive. Nine had died. Three remained in suspended animation, going on three or four weeks of ventilation. Four escaped the ventilator but remained in hospital.
-
-
@Klaus yes.
I've commented several times that staff, not equipment is a major problem. Not just ventilator drivers, but nurses, respiratory technologists, x-ray technicians, are critical to this.
The fact that driving a ventilator is complicated speaks against the simplistic solution of sharing ventilators with two or more patients.
-
-
@brenda When I've been harassed by docs in the past for not taking care of my asthma, the end of their lecture has always been something like, "and trust me, you don't want to be intubated." Luckily I've never had any experience with that. It does indeed sound terrible.
-
@brenda said in Ventilators are not a panacea:
I'm thinking Jolly's SIL and George's wife are right. I think those things sound frightening.
When I woke up from heart surgery I was intubated and restrained. I can only say it was like a prolonged aspiration event. The nurse tried to hold my hand and talk me down, while another person out me under again.
My wife apologized to my nurse when she saw her hand. I almost broke it.
Always remember, Operation Valkyrie was an act of sedition.
Warning: I post things that interest me. Read and comment at your own discretion. -
@Jolly said in Ventilators are not a panacea:
@brenda said in Ventilators are not a panacea:
I'm thinking Jolly's SIL and George's wife are right. I think those things sound frightening.
When I woke up from heart surgery I was intubated and restrained. I can only say it was like a prolonged aspiration event. The nurse tried to hold my hand and talk me down, while another person out out me under again.
My wife apologized to my nurse when she saw her hand. I almost broke it.
Just to put that in perspective, I'm somebody with a pretty high pain tolerance. After getting my chest cracked and then extubated, I took one pop of Fentanyl post-op. Other than that, acetaminophen.
-
Most Critically Ill Patients with COVID-19 Survive with Standard Treatment
Clinicians from two hospitals in Boston report that the majority of even the sickest patients with COVID-19—those who require ventilators in intensive care units—get better when they receive existing guideline-supported treatment for respiratory failure. The clinicians, who are from Massachusetts General Hospital and Beth Israel Deaconess Medical Center, published their findings in the American Journal of Respiratory and Critical Care Medicine.
During the COVID-19 pandemic, hospitals around the world have shared anecdotal experiences to help inform the care of affected patients, but such anecdotes do not always reveal the best treatment strategies, and they can even lead to harm. To provide more reliable information, a team led by C. Corey Hardin, MD, PhD, an Assistant Professor of Medicine at Mass General and Harvard Medical School, carefully examined the records of 66 critically ill patients with COVID-19 who experienced respiratory failure and were put on ventilators, making note of their responses to the care they received.
The investigators found that the most severe cases of COVID-19 result in a syndrome called Acute Respiratory Distress Syndrome (ARDS), a life-threatening lung condition that can be caused by a wide range of pathogens. “The good news is we have been studying ARDS for over 50 years and we have a number of effective evidenced-based therapies with which to treat it,” said Dr. Hardin. “We applied these treatments—such as prone ventilation where patients are turned onto their stomachs—to patients in our study and they responded to them as we would expect patients with ARDS to respond.”
Importantly, the death rate among critically ill patients with COVID-19 treated this way—16.7%—was not nearly as high as has been reported by other hospitals. Also, over a median follow-up of 34 days, 75.8% of patients who were on ventilators were discharged from the intensive care unit. “Based on this, we recommend that clinicians provide evidence-based ARDS treatments to patients with respiratory failure due to COVID-19 and await standardized clinical trials before contemplating novel therapies,” said co–lead author Jehan Alladina, MD, an Instructor in Medicine at Mass General.
