Some Doctors Are Questioning the Use of Ventilators

With hospitals around the country desperately short of ventilators as the COVID-19 crisis intensifies, some doctors are calling for a rethink of how they are used, arguing that a new disease might require a new approach. Skeptics, who note that studies show more than half of coronavirus patients placed on ventilators do not survive, fear they may be doing more harm than good for some patients, Yahoo News reports. Officials in New York City say up to 80% of COVID-19 patients placed on machines died. Doctors say that with ventilators in short supply, they are trying new treatments to keep patients off ventilators for as long as possible, including less invasive nose tubes and placing patients in different positions to aid breathing. More:

• Ventilation "is not benign." Mechanical ventilation, which forces oxygen into a patient's lungs after they are sedated, can damage lung sacs over time. Some doctors believe it can also trigger a dangerous immune system reaction. "We know that mechanical ventilation is not benign," Dr. Eddy Fan, an expert on respiratory treatment at Toronto General Hospital, tells the AP. “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."

• A "baffling observation." STAT reports that doctors have made the "baffling observation" that some COVID-19 patients have blood levels so low "they should be dead" but are now showing other symptoms associated with respiratory distress. Doctors say this suggests some patients are being placed on ventilators too early because of protocols developed for other illnesses. But "it’s hard to switch tracks when the train is going a million miles an hour,” said New York City critical care physician Cameron Kyle-Sidell.
• Long-term effects. Doctors are warning that even those who survive after spending a long time on ventilators are likely to suffer lingering effects including muscle atrophy and cognitive decline, Science reports. "As we learn the faces of the disease, we’re seeing our practices shift,” says C. Terri Hough, a pulmonary critical care physician at the University of Washington, Seattle. “If we’re putting more people on ventilators than maybe we need to, that certainly is going to affect the population health after recovery.”
• Rapid declines. Doctors have limited time to make decisions about placing patients on ventilators because of what some call the "insane" speed at which some patients decline, reports Reuters. Patients with strong oxygen levels can end up on ventilators within hours because of a "cytokine storm" caused by an immune system overreaction to the virus. "The scary thing is there are no rules to it," says a resident emergency doctor at New York-Presbyterian Hospital. He says doctors have resorted to using unproven treatments like hydroxychloroquine. "We're throwing the kitchen sink at these patients," he says.
• Sometimes, there is no alternative. Doctors are experimenting with less invasive alternatives like the masks sometimes used for sleep apnea, but with some seriously ill patients, ventilators are their only chance of survival. Dr. Marjorie Jenkins, dean of the University of South Carolina School of Medicine, says the acute respiratory distress seen in some COVID-19 patients is "uniformly fatal" without mechanical intubation. "Doctors are on the front lines to save lives, not to allow patients to suffer a horrible death," she tells USA Today. "A death that comes via slow painful suffocation for minutes, hours, perhaps days."

(More coronavirus stories.)