New Study Shows Nearly 9 in 10 Covid-19 Patients on Ventilators Don't Make It

[highplainsdem]

Source: Bloomberg

A giant study that examined outcomes for more than 2,600 patients found an extraordinarily high 88% death rate among Covid-19 patients in the New York City area who had to be placed on mechanical devices to help them breathe.

The study, published in the Journal of the American Medical Association, is one of the largest reviews published to date of Covid-19 patients hospitalized in the U.S. The researchers examined outcomes for coronavirus patients who were admitted between March 1 and April 4 to 12 hospitals in New York City and Long Island that are part of the Northwell Health system.

Overall, the researchers reported that 553 patients died, or 21%. But among the 12% of very sick patients that needed ventilators to breathe, the death rate rose to 88%. The rate was particularly awful for patients over 65 who were placed on a machine, with just 3% of those patients surviving, according to the results. Men had a higher mortality rate than women.

-snip-

With no proven drugs, ventilators are one of the go-to options for ICUs and critical care doctors in working with severe cases of Covid-19 pneumonia. But there are growing reports that few patients who get on the machines are able to get off. As a result, some doctors are questioning their use in Covid-19 patients and have been trying to find methods for keeping coronavirus patients off them when possible.

-snip-

Read more: https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study

[EllieBC]

1. Wasn't Don Lemon talking to a doctor who said they

were trying at his hospital in NYC to use BiPAP and a facedown position to better results? It was like 2 weeks ago almost this doctor was on his show I think.

If ventilators aren’t helping....stop doing it!

[Demsrule86]

4. It is a last resort and I think the number of those who live is higher.

[BigDemVoter]

11. I work in a hospital, and we place even the less critical Covid patients on their bellies

and rotate them to their backs every few hours. It does help In the ICU, there are 'proning' beds that can be flipped upside down and then turned back. The big danger in ICU with proning patients without the special beds is that it is very, very easy to accidentally extubate (pull endotracheal tube out) patient and pull IV lines that may be runnig vasoactive drips that keep patient alive.

It's interesting that proning has been successful. We started doing this many years ago in ICU with patients who developed Acute Respiratory Distress Syndrome (ARDS) usuallly relted to sepsis. At that time, patients' lungs would become stiff and would fill with fluid. The prone position would theoretically open the airway more and make it easier to breathe. Additionally, ventilators can be more complicated than people realize in that they have different "modes" to use, depending on what is wrong with the patient and depending on whether patient needs only a little assistance to breath or if patient is completely reliant on ventilator. I understand that using increased PEEP (positive end expiratory pressure) is not good with Covid patients, as their lungs are not stiff in the same way they are with ARDS, and there is more of a risk of barotrauma---burst alveoli.

[EllieBC]

16. My oldest was in the NICU for a few months.

They always had the babies on their bellies. So much so it was a battle to get them to stay on their backs once they went home. The nurses always said their O2 saturation and heart rate was less labile what way.

[LymphocyteLover]

24. good info-- thanks

[paleotn]

13. Read that....

and ran it by my better half. That's her world, not mine. Initial data seems to suggest an uptick in survival rates, but more study needs to be done and quickly. Tough to do since ventilators are standard practice. Getting patients and family to go along isn't easy, plus ethical issues of denying what's normally life saving practice. But then again, if it ain't working, it ain't working. Still tons to learn about this disease.

[DrToast]

18. You don't know if ventilators aren't helping.

[EllieBC]

19. I wasn't saying I do...

I was saying a doctor on Lemon's show who was working in a hospital in NYC said they weren't so they were trying BiPAP. And this article doesn't seem to offer a lot of hope that they are working.

[SheltieLover]

2. I read an article talking about this. Link below

It is apparently the blood clots that are killing people, from what I read.

https://www.statnews.com/2020/04/16/blood-clots-coronavirus-tpa/

[stillcool]

5. that's an interesting article..

thanks.

“It’s not necessarily the virus killing people, it’s the organ failure that happens as a result of the viral infection,” Barrett said. “If you can support people through their organ failure, … the immune system will eventually clear out the virus.”

The three patients in Barrett’s case reports, all of whom were on ventilators to help them breathe, initially did better when they were given tPA in what’s known as off-label use in salvage therapy. One of them died, one of them improved briefly, and one of them had a durable response, he said.

[SheltieLover]

8. YW

Loads of great info at statnews and no paywall! 👍

[stillcool]

3. if ventilators are used to help people breathe..

what difference does it make if the patient dies? I don't get what this study is trying to claim...really sick people are ventilated...and then they die? Why should their last breaths have them going gently into that good night?

The mortality rate in the study may not represent the ultimate picture that emerges. That’s because the study only included patients for whom a definite outcome is known-- those who died or were discharged. It didn’t include patients still being treated at hospitals. Outcome data were available for just 2,634 of 5,700 patients admitted during the study period.

Northwell Health researchers involved in the study said they were aware of the debate over when to use mechanical ventilation in Covid-19 patients, but noted that the observational nature of the study made it impossible to draw any conclusions about how best to use of ventilators in coronavirus patients.

[LymphocyteLover]

25. one concern is using a ventilator is very labor intensive and very expensive

it may not be the best use of limited resources if they aren't saving patients.

Your point about helping the patient breathe is well-taken but these are difficult issues when hospitals are under extreme stress.

[Laelth]

6. Horrifying and shocking.

We’re short on ventilators, but, according to this study, they don’t help much if you have symptoms that are severe enough to warrant one.

If 88% of the people who get ventilators die, one could assume that a ventilator will only increase your chances of survival by about 12%.

That is both horrifying and shocking to me.

-Laelth

[SheltieLover]

10. See posts w & 5 👆

Docs are thinking the culprit might be blood clots. In lungs & other organs.

[jimlup]

7. Yeah once you are on a vent...

it is not good. But we need to fight like hell for that few percent that do recover!

[SheltieLover]

9. Absolutely)!

[paleotn]

14. Thus the rub.....

Of those who need a ventilator, who's to say who will be in the roughly 10% that survive? Tough call for patient and family. With conventional treatment you have a 10% chance of survival and 90% morbidity. But there's another school of thought that might give you better odds, but no guarantee. Tough call I wouldn't want to make. I marvel at my wife's world. In mine, if something doesn't work out we may cost the company some bucks, but learn from the mistakes and do something different...and no one ends up dead that mighta, coulda, shoulda lived.

[treestar]

20. True. Boris Johnson is in that group.

He was put on one, but recovered.

[Mosby]

22. He was never on a ventilator

He was given oxygen.

[treestar]

23. I stand corrected

Thanks.

[Voltaire2]

12. 55-65% mortality after ventilator

is normal, plus all sorts of other horrible but non lethal consequences.

[treestar]

15. If 10% survive

Then they deserve that chance.

[Igel]

17. It's a trade off, a numbers game.

If you have 100 people and 70 die with proning and 88 with ventilators, you go with the proning. (That "70" is a completely made up number, by the way--could be 40, could be 87, etc.)

Even if the 12 who'd have lived wind up dying, it's the right choice. That's something you could never actually know, so it's not as crass as it sounds. And until you can tell how to separate them out for proning or ventilator, you go with the higher survival rate.

[dreamland]

21. What if the ventilators were actually helping the virus spread?

The virus still exists in the body. The ventilators are to help people breathe. What if the ventilators also act as a transport for the virus?