I’ve seen a few reports and articles the past couple days that question the high level of ventilator use with advanced covid patients. The points I’ve seen mentioned include:
1. As data accrue, we see somewhere between 50% and 80% once intubated and put on invasive ventilator do not survive.
2. These invasive ventilators force air into the lungs but if the patient is experiencing a cytokine storm from ARDS, when the persons immune system while attacking the virus in the lungs keep the lungs from effectively oxygenating they bloods which is the main danger of death in advanced covid, this may not Be sufficient to overcome the main problem.
3. This forceful pushing of air into lungs can cause damage to lungs which could lead to inflammatory response that could potentially worsen the ARDS.. These invasive ventilators also tend to produce major exhalation of aerosols making it easier for it to spread to anyone around the intubated patient.
The practice of putting on ventilator is done because it is standard medical practice when oxygen levels are very low but these articles are emphasizing this may not be best practice so many doctors are trying to avoid it and not move to it too soon.
Of course to definitively learn whether it helps or hurts we would need randomized trials, but that is not feasible or perhaps ethical in these settings so the medical community may have to try to figure it out the best they can and share data and results to help others know what to do in real time.
This highlights the unique challenges this new virus brings to healthcare that is different from other respiratory illnesses and may call for new approaches (i.e. thus is not just a bad flu or case of pneumonia), yet we are experiencing surges of these cases that the doctors have to treat with best available information whether we have results from rigorous evidence based studies or not (I.e. the bar is not that we have to wait for randomized study results before we try a potential treatment strategy).
This is a new challenge but I am confident our medical community can figure out what is working and what is not and adjust on the fly, and I am confident our scientific community which has already designed and started rigorous studies in record time even in this chaos that, where possible, will give us rigorous answers; and that our innovative researchers and companies will find and develop effective vaccine and treatments in an accelerated pace. I think we all need to focus on rooting for that, celebrating these joint efforts, and not get caught up in the political angles.
