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.