Doctors urge caution when using ventilators for coronavirus patients

Doctors are now warning against the rush to use mechanical ventilators to treat coronavirus patients, saying that the breathing machines could be doing more harm than good.

While medical professionals in several countries battling the global pandemic agree that ventilators have helped save lives, the risks of using the overly intrusive machines could be too high for many patients, according to a survey of medical personnel in various countries by Reuters.

Instead, health workers have begun prescribing less intrusive oxygen facemasks, which don’t require patients to have a tube inserted into their respiratory system.

“Initially we were intubating fairly quickly on these patients as they began to have more respiratory distress,” Robert Hart, chief medical director at Ochsner Health, Louisianna’s largest hospital chain, told Reuters.

“Over time what we learned is trying not to do that. We seem to be getting better results.”

Luciano Gattinoni, a guest professor for the Department of Anaesthesiology, Emergency and Intensive Care Medicine at the University of Göttingen in Germany — and a renowned expert in ventilators — was one of the first to raise questions about how ventilators should be used to treat COVID-19.

“I realized as soon as I saw the first CT scan … that this had nothing to do with what we had seen and done for the past 40 years,” he told Reuters.

In a paper published by the American Thoracic Society on March 30, Gattinoni and other Italian doctors wrote that COVID-19 does not lead to “typical” respiratory problems.

Patients’ lungs more elastic and were working better than they would expect for acute respiratory distress syndrome (ARDS), they wrote. Therefore, ventilating some COVID-19 sufferers is not appropriate.

“It’s like using a Ferrari to go to the shop next door, you press on the accelerator and you smash the window,” he said.

Gov. Andrew Cuomo
Gov. Andrew CuomoHans Pennink

US government officials, including Gov. Andrew Cuomo and President Donald Trump, have repeatedly bemoaned the shortage of ventilators to combat the spread of the coronavirus, with car manufacturers and medical supply companies enlisted to create as many of the machines as possible.

But in a report this week, the Journal of the American Medical Association found that nearly 90 percent of COVID-19 patients hooked up to a ventilator in New York’s largest hospital system, Northwell Health, died anyway.

In a YouTube video published earlier this month, Cameron Kyle-Sidell, a New York physician, said he feared that by preparing to put patients on ventilators, hospitals in America were treating “the wrong disease.”

Ventilation, he said, would lead to “a tremendous amount of harm to a great number of people in a very short time.” This remains his view, he told Reuters.

In China, 86 percent of coronavirus patients put on mechanical ventilators in an intensive care unit in Wuhan, where the outbreak originated, died from the virus.

Similarly in the UK, a study of COVID-19 patients found that two-thirds of those put on the breathing machines died.

And in Germany, Thomas Voshaar, a German pulmonologist at the Bethanien hospital lung clinic, told Reuters that of the 36 acute COVID-19 patients on his ward in mid-April, one had been intubated — a man with a serious neuro-muscular disorder — and he was the only patient to die. Another 31 had recovered.

However, doctors stress that it doesn’t mean the ventilators caused the deaths — just raises important questions about the best treatment options for some patients.

Rather than rushing to intubate, doctors say they now look for other ways to boost the patients’ oxygen.

With Post wires


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