Home Chinese Virus Doctors are losing their faith in ventilators

Doctors are losing their faith in ventilators

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As health officials around the world push to get more ventilators to treat coronavirus patients, some doctors are moving away from using the breathing machines when they can.

The reason: Some hospitals have reported unusually high death rates for coronavirus patients on ventilators, and some doctors worry that the machines could be harming certain patients.

The evolving treatments highlight the fact that doctors are still learning the best way to manage a virus that emerged only months ago. They are relying on anecdotal, real-time data amid a crush of patients and shortages of basic supplies.

Mechanical ventilators push oxygen into patients whose lungs are failing. Using the machines involves sedating a patient and sticking a tube into the throat.

Deaths in such sick patients are common, no matter the reason they need the breathing help.

Generally speaking, 40-50 per cent of patients with severe respiratory distress die while on ventilators, experts say. But 80 per cent or more of coronavirus patients placed on the machines in New York City have died, state and city officials say.

Higher-than-normal death rates also have been reported elsewhere in the US, said Dr Albert Rizzo, the American Lung Association’s chief medical officer.

Similar reports have emerged from China and the United Kingdom. One UK report put the figure at 66 per cent. A very small study in Wuhan, the Chinese city where the disease first emerged, said 86 per cent died.

The reason is not clear. It may have to do with what kind of shape the patients were in before they were infected. Or it could be related to how sick they had become by the time they were put on the machines, some experts said.

But some health professionals have wondered whether ventilators might actually make matters worse in certain patients, perhaps by igniting or worsening a harmful immune system reaction.

That’s speculation. But experts do say ventilators can be damaging to a patient over time, as high-pressure oxygen is forced into the tiny air sacs in a patient’s lungs.

 

“We know that mechanical ventilation is not benign,” said Dr Eddy Fan, an expert on respiratory treatment at Toronto General Hospital. “One of the most important findings in the last few decades is that medical ventilation can worsen lung injury, so we have to be careful how we use it.”

The dangers can be eased by limiting the amount of pressure and the size of breaths delivered by the machine, Fan said.

But some doctors say they’re trying to keep patients off ventilators as long as possible, and turning to other techniques instead.

Alternate solutions

Only a few weeks ago in New York City, coronavirus patients who came in quite sick were routinely placed on ventilators to keep them breathing, said Dr Joseph Habboushe, an emergency medicine doctor who works in Manhattan hospitals.

But increasingly, physicians are trying other measures first. One is having patients lie in different positions – including on their stomachs – to allow different parts of the lung to aerate better. Another is giving patients more oxygen through nose tubes or other devices.

Other physicians are experimenting with adding nitric oxide to the mix, to help improve blood flow and oxygen to the least damaged parts of the lungs.

“If we’re able to make them better without intubating them, they are more likely to have a better outcome – we think,” Habboushe said.

He said those decisions are separate from worries that there are not enough ventilators available. But that is a concern as well, Habboushe added.

There are widespread reports that coronavirus patients tend to be on ventilators much longer than other kinds of patients, said Dr. William Schaffner, an infectious diseases expert at Vanderbilt University.

Experts say that patients with bacterial pneumonia, for example, may be on a ventilator for no more than a day or two. But it’s been common for coronavirus patients to have been on a ventilator “seven days, 10 days, 15 days, and they’re passing away,” said New York Governor Andrew Cuomo, when asked about ventilator death rates during a news briefing on Wednesday.

New York State Health Commissioner Dr Howard Zucker said on Wednesday that officials are looking into other possible therapies that can be given earlier, but added “that’s all experimental.”

“The ventilator is not therapeutic. It’s a supportive measure while we wait for the patient’s body to recover,” said Dr Roger Alvarez, a lung specialist with the University of Miami Health System in Florida, who is a leader in the effort to use nitric oxide to keep patients off ventilators for as long as possible.

-AAP

12 COMMENTS

  1. Posted late last night and fits in here with the Doctor’s dilemmas, and just how does this virus effect humans.

    It appears the virus may take a 2nd bite to the apple.
    This virus is like having caught a tiger by the tail.
    Seems like we are still in the petri dish, either with the sniffles, or dying for breath.
    A lot more research, to be done, and that all takes time.

    ….. Korean health officials reported Friday that 91 patients thought to have been cleared of the virus had tested positive again, up from 51 people on Monday. ……
    ………… patients testing positive again showed no symptoms, while others were suffering from fevers and respiratory issues, ……..
    …….. “We say that a patient has fully recovered when he or she tests negative twice within 24 hours. But the fact that some of them tested positive again in a short period means that the virus remains longer than we thought,” ………..
    “The number will only increase, 91 is just the beginning now,” ……..
    ……. Mr Kim also said patients had likely “relapsed” rather than been re-infected. ……

    https://www.yahoo.com/news/recovered-coronavirus-patients-test-positive-161747102.html

    Sort of like a virus cycle, through the shingles, often in the grand parents, that can infect the grand children, and so it goes round, unless a bit of preventive treatment.
    A bit too soon to know all the tricks of this CCP virus.

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  2. The CCP virus is racist ,scientists are discovering that the virus actually attacks different races of humans in different ways ,this might strengthen the conspiracy theory as to why the Chinese have supposedly had so few deaths and also the theory that it is a scientifically manipulated virus.
    I’m thinking that what is going to come out in the coming months will shock the entire world, there is no doubt that our comfortable way of life is changed forever and not for the better, thanks Xi Jinping you filthy communist C- – – T.

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    • If a virus has been “scientifically manipulated” then the fingerprints of the engineers will be all over the viruses RNA.

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      • Odakyu-sen

        You are, of course, assuming that (f what you suggest is correct) the governments of the countries concerned actually WANT to released that information? Through trade and other agreements, the CCP (aka ‘China’) has tentacles everywhere and sometimes it may not be in a nation’s interests to make such a public announcement.

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        • The public doesn’t need to know, but the intelligence agencies around the world will be looking into the matter.

          “We sleep soundly because rough men stand ready to visit violence on those who would do us harm.” (source unconfirmed)

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  3. For the ones who say it is just a sniffle, a bit of flue, knocking the aged of their perch., it does seem to “age a body” and its organs.
    This sort of explains why it takes out the last reserve of the old.

    …… mild and severe disease alike, the researchers found that many of the biological measures had “failed to return to normal. …….”
    …….. apparently recovered patients continued to have impaired liver function.
    ……. That was the case even after two tests for the live virus had come back negative and the patients were cleared to be discharged. ………..

    …… those without respiratory distress sustain injury to the heart, doctors have to wonder whether they have underestimated COVID-19’s ability to wreak lasting havoc.

    ….. “COVID-19 is not just a respiratory disorder,” said Dr. Harlan Krumholtz, a cardiologist at Yale University. “It can affect the heart, the liver, the kidneys, the brain, the endocrine system and the blood system.” ….
    https://www.sandiegouniontribune.com/news/science/story/2020-04-11/coronavirus-infection-can-do-lasting-damage-to-the-heart-liver
    The article just starts to as time allows, to pull back the cover of the possible affects on the survivors.

    Now there is a petri dish of survivors to be researched & studied.
    What will the longetivity of life be?, and will any new disabilities occur.
    A vaccine can not come soon enough. Will it be live vaccine or a dead vaccine.
    Seeing the above complications, I am not sure how many will want to be vaccinated in the first rush.

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  4. May be back full circle on ventilation machines.
    The iron lung ran aiding breathing by negative pressure, which seems to be more natural.
    The modern ventilators do that by positive pressure.

    Rows of iron lungs filled hospital wards at the height of the polio outbreaks of the 1940s and 1950s, helping children, and some adults, with bulbar polio and bulbospinal polio. A polio patient with a paralyzed diaphragm would typically spend two weeks inside an iron lung while recovering.
    https://en.wikipedia.org/wiki/Iron_lung

    Possibly a place for both, and it seems that sadly doctors will have a choice of guinea pigs.

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  5. The link I put yesterday from Jo Nova’s site gave a possible explanation of what is going on.

    These new observations also reinforces what Dr Zerenko ( one of the first doctors who publicise success using hydroxychloromine and Zinc) said . He wanted to avoid having people going to the hospital , meaning if they were that far along the process of deterioration the chance of recovery was dramatically reduced. That makes it sound like saying the obvious but I hope you get my meaning –catch it earlier and give treatment.

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  6. These guys just get on doing what they can find what is best for their countries.

    Brazilian President Jair Bolsonaro thanked Indian Prime Minister Narendra Modi this week for allowing raw materials to continue to flow into Brazil so they could maintain production of Hydroxychloroquine (HCQ), an anti-malaria drug, to treat patients of COVID-19,

    “We have more good news. As an outcome of my direct conversation with Prime Minister of India, we will receive, by Saturday, raw materials to continue our production of HCQ so that we can treat patients of COVID-19 as well as of Lupus, Malaria, and Arthritis.
    I thank Prime Minister Narendra Modi and the people of India for such timely help to the people of Brazil,” Bolsonaro stated.

    “An honorable gesture that can help save the lives of many Brazilians, and which we will never forget,” Bolsonaro added.

    May be it is right, maybe it is wrong, but doing something, it will soon prove itself right or wrong.

    Wringing hands of bureaucracy of either or neither, dithering like Ardern, who only wants adhans across the land, to pronounce the essentials of Easter Bunny & Tooth Fairy, to cover with the demanding, unquestioned fatwas.

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