When to ventilate—and when not to
Ventilators can save lives in the most severe cases of the coronavirus, but new research indicates doctors may overuse the medical technique and harm their patients. Some 50 percent of people diagnosed with COVID-19 and placed on ventilators die, and damage caused by the machine may account for some of those deaths, according to a study published on April 21 in the American Journal of Tropical Medicine and Hygiene.
The National Institutes of Health released guidelines on April 21 that encourage doctors to start with less invasive breathing support, like nasal cannulas. If mechanical ventilation becomes necessary, the NIH recommends delivering only low volumes of oxygen.
Physicians have clung to tried-and-true treatment methods typically used for pneumonia patients, but COVID-19 affects people differently than other types of viral pneumonia. “There is mounting evidence that lots of patients are tolerating fairly extreme” low levels of oxygen in the blood, suggesting less need for a ventilator, Muriel Gillick of Harvard Medical School, told Stat.
Patients with other types of pneumonia typically gasp for breath and can barely speak when their oxygen saturation level—a measure of how well their blood is oxygenated—drops below 90 percent. But at even much lower oxygen levels, COVID-19 patients can often speak in full sentences without getting winded and show no signs of respiratory distress.
Unlike with other viral types of pneumonia, areas of healthy, elastic lung tissue can sit right next to damaged areas in those with COVID-19. Forcing high-pressure oxygen-enriched air into elastic tissue in large volumes can cause tissue leaks, swelling, and inflammation and can result in increased mortality, the researchers wrote. —J.B.
Comments
NEWS2ME
Posted: Fri, 05/01/2020 12:55 pmWhen to ventilate and when not to--
I wonder how many people died because of the use of the extreme ventilator.
And hospitals were probably forced to use them, or lose them because they weren't using them.
NEWS2ME
Posted: Fri, 05/01/2020 12:57 pmCimon 2 and the astronaut
In the photo the astronaut has his arms crossed and looks skeptical about this robot. Interesting.
CaptTee
Posted: Fri, 05/01/2020 01:43 pmWhat was the success rate of ventilators before this year?
By "succes rate". I mean the percentage of people who were placed on ventilators and did not die after being removed from the ventilator?
Before this year, most people who I knew that were place on ventilators were so ill and weak that they would have died, if they hadn't been placed on the ventilator, and most did die after the ventilator was removed. So, from my limited experience (less than 5 people), a ventilator by itself, without other interventions to fight the root cause of the breathing difficulty, as a waste of time and money.