To Ventilate Or Not To Venilate?

That is the question asked by this very interesting article at STAT by Sharon Begley:

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.

That’s not unreasonable. In patients who are on ventilators due to non-Covid-19 pneumonia or acute respiratory distress, a blood oxygen level in the 80s can mean impending death, with no room to give noninvasive breathing support more time to work. Physicians are using their experience with ventilators in those situations to guide their care for Covid-19 patients. The problem, critical care physician Cameron Kyle-Sidell told Medscape this week, is that because U.S. physicians had never seen Covid-19 before February, they are basing clinical decisions on conditions that may not be good guides.

“It’s hard to switch tracks when the train is going a million miles an hour,” said Kyle-Sidell, who works at a New York City hospital. “This may be an entirely new disease,” making ventilator protocols developed for other conditions less than ideal.

Read the whole thing. Remember, these decisions are being made in good faith and on the fly. They aren’t scientific in the sense that they’ve been rigorously tested. They’re being made based on experience, convention, the standard of care, and guesswork.

I found lots of interesting observations in the article including that people with COVID-19 look more like people with altitude sickeness than they do like people with pneumonia. I can’t testify as to the veracity of any of this but it is interesting.

8 comments… add one
  • steve Link

    This is offensively stupid.


  • Larry Link

    Steve, I agree!

  • GreyShambler Link

    Still a good question. Out of New York I hear 80% of patients on vents die. The rest have permanent lung damage. If the patient doesn’t make the call in advance, he’ll go on the vent.

  • jan Link

    Consensus and/or conventional thinking does not always provide the best kind of problem solving.

  • Susan G Link

    Interesting article. And coincidentally this is a topic I have been thinking a lot about. It is my feeling that intubation is mostly a death sentence for most patients with Covid 19. Lately I have been seeing more and more articles and videos by health professionals, encouraging people with Covid 19 at home to do physical therapy: deep breathing exercises (even though it’s painful), chest physical therapy (repeated percussion of the back, as is used for Cystic Fibrosis), postural drainage (assuming a position that encourages gravitational draining of the lungs.) Right now I wish my primary doctor was a really good naturopath.

  • steve Link

    Realized I should thank you for highlighting this. My wife and other people also mentioned this. This was more widely read then physicians caring for patients realized. I forwarded it to our critical care and ID team and they will be preparing something both for our staff and the public to alleviate fears about this and inform people about how we actually care for patients.


  • It must be a pain in the arse dealing with disinformation while trying to devote maximum energy to patient care.

  • steve Link

    Sort of, but for the most part I think people mean well. There is just so much uncertainty and people are still scared. Also, I live in a bubble right now so I dont know what all is bouncing around in the rest of the world. What is obvious to me wont be for other people. Plus, as always, I could be wrong.


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