Are Ventilators Killing More People Than Coronavirus?

The death rate for those treated on ventilators is devastating. In one British study of 98 Covid-19 patients who were put on them or on similarly invasive breathing-support equipment, two-thirds died, according to a new report by our Intensive Care National Audit and Research Centre.

In New York, which has been hit particularly hard by the virus, 80 per cent of ventilated patients failed to recover. The loss of life in other countries for those on the machines is equally terrifying. __ When Ventilators Kill

Update: Nearly all the coronavirus patients placed on ventilators at a large New York health system died

There seems to be something different about COVID-19 patients, that makes them vulnerable to the conventional ways in which mechanical ventilators are generally used for routine forms of respiratory failure.

The question is whether ICU physicians are moving patients to mechanical ventilators too quickly. “Almost the entire decision tree is driven by oxygen saturation levels,” said the emergency medicine physician, who asked not to be named so as not to appear to be criticizing colleagues. __ STATNews

Mechanical ventilation puts a person at additional risk for blood clots. Some physicians are suggesting the use of tissue plasminogen activator (tPA) in patients with Wuhan CoV-19 who require treatment in the ICU.

Ventilators can easily kill you. Especially when you are being kept deeply sedated and helpless the whole time. It is a lot like being under general anesthesia for days or weeks at a time. Even a healthy person would be at a distinct risk of dying in such a setting, from several different complicating problems.

Mechanical Ventilation: Knock Them Out and Breathe for Them

The use of mechanical ventilation in respiratory failure, is always fraught with danger. In the case of Wuhan CoV-19, doctors and therapists are flying by the seat of their pants, with a crash and burn all too possible.

“It is a new disease and none of the American doctors have encountered it in their lives, not in textbook and they are figuring things out by experience.”

Dr David Farcy, head of emergency medicine at Mount Sinai Medical Center in Miami Beach, Florida, told NBC News: “I’ve never seen anything like this. This has challenged every dogma, has channelled every belief, has challenged anything I’ve studied.” __ Ventilators are Unnecessarily Destroying Lungs

Having been frightened for weeks of a “massive ventilator shortage,” sober epidemic watchers have awakened to something quite different. The evidence suggests that the inappropriate use of ventilators in treating the pulmonary complications of Wuhan CoV-19 may be killing more people than the virus itself.

Researchers in Wuhan, for instance, reported that, of 37 critically ill Covid-19 patients who were put on mechanical ventilators, 30 died within a month. In a U.S. study of patients in Seattle, only one of the seven patients older than 70 who were put on a ventilator survived; just 36% of those younger than 70 did. And in a study published by JAMA on Monday, physicians in Italy reported that nearly 90% of 1,300 critically ill patients with Covid-19 were intubated and put on a ventilator; only 11% received noninvasive ventilation. One-quarter died in the ICU; 58% were still in the ICU, and 16% had been discharged.

Older patients who do survive risk permanent cognitive and respiratory damage from being on heavy sedation for many days if not weeks and from the intubation, Gillick said. __ Ventilators Overused

A person might be admitted through the ER with a presumptive diagnosis of Covid-19, be found to have an O2 saturation of 70%, and be immediately sedated, intubated, and placed on mechanical ventilation — then shipped up to the ICU. From there, any number of deadly complications can ensue, none of them as a direct result of any respiratory virus. Whether or not the person ever had the SARS-2 coronavirus, he will be just as dead — and his death certificate will state that he died of COVID-19. Was the pulse oximeter defective? Could the patient have been re-oxygenated with a few simple bedside maneuvers? Did the medics rush into ventilator therapy prematurely, or were the ventilator settings wrong for the particular condition of the patient’s lungs? Once you are in the lion’s den, do not be surprised to wake up with your head missing.

Perhaps 100,000 Americans die yearly at least partially from adverse effects of medical treatment (AEMT). This is a lot less than the over-hyped numbers you usually hear from lawyers and their friends in the media, but it is far too many. The deeper one goes in the hospital dungeons — the more heroic the measures that are taken — the greater the risk of something going wrong.

As patients go downhill, protocols developed for other respiratory conditions call for increasing the force with which a ventilator delivers oxygen, the amount of oxygen, or the rate of delivery, she explained. But if oxygen can’t cross into the blood from the lungs in the first place, those measures, especially greater force, may prove harmful. High levels of oxygen impair the lung’s air sacs, while high pressure to force in more oxygen damages the lungs. __ Ventilator Overuse

A fatal complication from mechanical ventilation (and intensive care in general), can happen to anybody. In the Rube Goldberg world of “making it up as you go pandemic medicine,” anything can happen.

Most complications of mechanical ventilation are related directly to the disruption of the normal cardiopulmonary physiology. Normal pulmonary physiology involves creating a negative pressure in the airways by the diaphragm and the chest wall, whereas positive pressure ventilation (i.e., the vast majority of modern ventilators) involves forcing air into the airways under pressure.

Others are a combination of the above and being critically ill. It is essential to be aware of these complications so that they can be recognized early and intervened upon. __ Complications of Mechanical Ventilation

Hospitals may have various incentives for treating someone with a diagnosis of COVID-19 very aggressively. In the atmosphere of panic that has been drummed up for Wuhan CoV-19, the spirit in the ER is to take it to the max. But it is in the life and death decisions that we must try the hardest to be sure we have gotten it right.

The hyper-aggressive approach to mechanical ventilation has been driven by medical information that came out of China. But there comes a time when you must give up on an unreliable source of information, and start learning from your own experiences.

You may discover that a lot more people do not have to die.

Update: The frequent problem of multiple blood clots in coronavirus patients:

A Dutch study published April 10 in the journal Thrombosis Research provided more evidence the issue is widespread, finding 38% of 184 covid-19 patients in an intensive care unit had blood that clotted abnormally. The researchers called it “a conservative estimation” because many of the patients were still hospitalized and at risk of further complications.

Early data from China on a sample of 183 patients showed that more than 70% of patients who died of covid-19 had small clots develop throughout their bloodstream. __ Seattle Times

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2 Responses to Are Ventilators Killing More People Than Coronavirus?

  1. Gavin Longmuir says:

    There have been some reports that we have misunderstood the mechanism by which C-19 leads to death. The new hypothesis is that some proteins produced by the virus displace iron from hemoglobin, thereby preventing red blood cells from transporting oxygen from the lungs to the vital organs. Starved of oxygen, the vital organs collapse.

    This hypothesis is based in part on molecular modeling, and in part on observations of increased amounts of iron being held in the blood outside of red blood cells (presumably displaced from hemoglobin).

    Ventilation of patients is based on the prior hypothesis that the reason for the low oxygen saturation in the patients blood is the difficulty of getting oxygen into the lungs because of swelling of the airways. But if the problem lies in transferring the oxygen from the lungs into the blood stream, then ventilation will not help.

    • alfin2101 says:

      An interesting hypothesis. The virus does seem to affect the hematologic systems of the infected. We really don’t understand all the quirks of this tricky Chinese virus.

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