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Are Ventilators Killing More People Than They're Saving??
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“Researchers in Wuhan…reported that, of 37 critically ill Covid-19 patients who were put on mechanical ventilators, 30 died within a month. In a U.S. study of patients in Seattle, only one of the seven patients older than 70 who were put on a ventilator survived; just 36% of those younger than 70 did.” (“With ventilators running out, doctors say the machines are overused for Covid-19”, STAT News)

Think about that for a minute. What these figures mean is that, if you’re over 70 and you’re put on a ventilator because you have coronavirus, you’re probably going to die. More importantly, it means that it was probably the ventilator that killed you. Isn’t that something the public ought to know?

I think it is.

“One in seven” is very poor odds. They aren’t the odds a rational person would bet his life on unless he had a death wish or a very serious gambling problem. So what’s going on here, and why is there so much misleading blabber about ventilators?

The root problem seems to be that coronavirus is a relatively new phenomenon and the methods for treating it are still in their early phases. Nothing is set in stone, not yet at least. Even so, you might have noticed that, when British Prime Minister Boris Johnson contracted the infection and was bundled off to ICU, the medical team did NOT put him on a ventilator, but put him on oxygen instead. And the difference couldn’t be more striking, because today, after 3 days in ICU, Johnson is alive, whereas he probably would be dead if he was intubated. Yes, I am making a judgment about something of which I cannot be entirely certain, but I think I’m probably right. If Johnson had been put on a ventilator, he probably would have died.

But, why, that’s what we want to know?

The answer to that question can be found in the article cited above. Take a look:

“Many (coronavirus) patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen.

That is making critical care physicians suspect that blood levels of oxygen, which for decades have driven decisions about breathing support for patients with pneumonia and acute respiratory distress, might be misleading them about how to care for those with Covid-19. In particular, more and more are concerned about the use of intubation and mechanical ventilators. They argue that more patients could receive simpler, noninvasive respiratory support, such as the breathing masks used in sleep apnea, at least to start with and maybe for the duration of the illness.

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.” (“With ventilators running out, doctors say the machines are overused for Covid-19”, STAT News)

Okay, so doctors are making their decisions based on “blood oxygen levels”, right? But blood oxygen levels might signal the need for a different treatment for coronavirus patients than they do for pneumonia and acute respiratory distress syndrome (ARDS) patients. In other words, one size does not fit all. The problem is that too many people are ending up on ventilators when ventilators are undermining their chances for survival. Here’s more:

“….one of the most severe consequences of Covid-19 suggests another reason the ventilators aren’t more beneficial. In acute respiratory distress syndrome, which results from immune cells ravaging the lungs and kills many Covid-19 patients, the air sacs of the lungs become filled with a gummy yellow fluid. “That limits oxygen transfer from the lungs to the blood even when a machine pumps in oxygen,” Gillick said.

As patients go downhill, protocols developed for other respiratory conditions call for increasing the force with which a ventilator delivers oxygen, the amount of oxygen, or the rate of delivery, she explained. But if oxygen can’t cross into the blood from the lungs in the first place, those measures, especially greater force, may prove harmful. High levels of oxygen impair the lung’s air sacs, while high pressure to force in more oxygen damages the lungs.

“We need to ask, are we using ventilators in a way that makes sense for other diseases but not for this one?” Gillick said. “Instead of asking how do we ration a scarce resource, we should be asking how do we best treat this disease?” (STAT News)

Can you see the problem? Virus victims develop a mucousy-yellow gunk in their lungs that prevents oxygen from transferring to the blood. Forcing more air into their lungs with a ventilator, doesn’t help that process, it just damages the lungs. In short, it is the wrong treatment for this particular illness. This explains why Johnson was not put on a ventilator, because the risks far outweighed the potential benefits. Here’s more from the same article:

“In a small study last week in Annals of Intensive Care, physicians who treated Covid-19 patients at two hospitals in China found that the majority of patients needed no more than a nasal cannula. Among the 41% who needed more intense breathing support, none was put on a ventilator right away. Instead, they were given noninvasive devices such as BiPAP; their blood oxygen levels “significantly improved” after an hour or two. (Eventually two of seven needed to be intubated.) The researchers concluded that the more comfortable nasal cannula is just as good as BiPAP and that a middle ground is as safe for Covid-19 patients as quicker use of a ventilator…..“Anecdotal experience from Italy [also suggests] that they were able to support a number of folks using these [non-invasive] methods,” Japa said.” (STAT News)

So the treatment for patients with coronavirus is rapidly evolving, but serious mistakes are undoubtedly still being made. One can only wonder how many people might have survived their trip to ICU had their physicians been more aware of the non-invasive alternatives? But don’t think for a minute that I’m blaming anyone for using methods or devices that may be discarded in the near future. I’m not, but from my vantage point, it looks like the over-dependence on ventilators might have been a very costly mistake. Check out this last clip from the article:

“Because U.S. data on treating Covid-19 patients are nearly nonexistent, health care workers are flying blind when it comes to caring for such confounding patients. But anecdotally, Weingart said, “we’ve had a number of people who improved and got off CPAP or high flow [nasal cannulas] who would have been tubed 100 out of 100 times in the past.” What he calls “this knee-jerk response” of putting people on ventilators if their blood oxygen levels remain low with noninvasive devices “is really bad. … I think these patients do much, much worse on the ventilator.

That could be because the ones who get intubated are the sickest, he said, “but that has not been my experience: It makes things worse as a direct result of the intubation.” High levels of force and oxygen levels, both in quest of restoring oxygen saturation levels to normal, can injure the lungs. “I would do everything in my power to avoid intubating patients,” Weingart said.” (STAT News)

“Flying blind” sums it up perfectly. Doctors and health care workers have proceeded on the basis of guesswork and intuition without any empirical evidence that they’ve settled on the proper treatment for the infection. That should give us all pause.

Assuming that we’re still in the early days of the pandemic, many of us might have to decide whether we’ll allow ourselves or a loved one to be put on a ventilator. This new research could help us to make a more informed decision. I certainly hope so.

Please watch this excellent 6 minute video of Dr Cameron Kyle Sidell, E.R. and Critical Care Doctor, NY City

 
• Category: Science • Tags: Coronavirus 
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  1. I’m willing to bet Tony knows this. He wants to drive up the mortality. He helped kill plenty of people with AZT.

  2. Excellent article. I was going to mention Boris Johnson’s case in a comment elsewhere, and now I am glad someone stepped ahead of me.

    Let’s hope more people become aware of these facts and that the medical class corrects its course soon. I for one am of the opinion, already expressed on this webzine, that a quarantine of doctors — or of the clinician subcategory at the very least — for a long, long time would be very beneficial for their health and ours (include the mental health there).

    In the age of the internet, the libertarian approach should extend to medicine as well. Perhaps surgeons and people who perform exams using complex tools could be kept; they are highly trained artisans and their skills are valuable. As for the prescribers, policy makers and other opinion merchants, my wish for them is: stay at home.

    And of course the WHO should in the future be only the name of a band who once sang ‘we won’t get fooled again’.

    • Replies: @marketapley
  3. botazefa says:

    More importantly, it means that it was probably the ventilator that killed you

    Isn’t it obviously more likely that the ventilator simply failed to save you?

    By your logic, if a person having a heart attack gets defibrillated and dies, it was the defibrillator that killed him.

    If you are facing being placed on a ventilator it is because you are likely to die of respiratory failure imminently without it.

    • Replies: @Jmaie
  4. Senator Dr. Scott Jensen: Right now Medicare is determining that if you have a COVID-19 admission to the hospital you get $13,000. If that COVID-19 patient goes on a ventilator you get $39,000, three times as much.

  5. Thomasina says:

    Botazefa – exactly. From what I’ve read, the best results are being obtained from the combination of Hydroxychloroquine (a cheap off-patent anti-malarial drug) and Azithromycin (antibiotic for the secondary bacterial infection that develops in the alveoli).

    There is most definitely a narrative being driven by a few key people, including one Youtuber who gives a daily rundown on the virus, and it is being directed AWAY from the above combination that many doctors have reported a high success rate with. Why is that? Is it because the drugs are cheap? Is everybody stalling for a vaccine to enrich the pharmaceutical companies?

    This disease is affecting the elderly the hardest, but the largest study done so far in the U.S. has found this:

    “The chronic condition with the strongest association with critical illness was obesity, with a substantially higher odds ratio than any cardiovascular or pulmonary disease.”

    https://www.zdnet.com/article/nyu-scientists-largest-u-s-study-of-covid-19-finds-obesity-the-single-biggest-factor-in-new-york-critical-cases/

    One report of the combination I first mentioned is this 102 year old woman:

    https://newyork.cbslocal.com/2020/04/11/102-year-old-woman-recovers-from-coronavirus/

    But above it all, I still believe this virus is being used as an excuse to shut down the economy, create a panic, and instill fear in order to bail out the financial system that was about to roll over all on its own.

    Create a crisis in order to bail out the crooks.

    • Thanks: botazefa
    • Replies: @SysATI
  6. Paulbe says:

    The inherent corruption of Medicine in the US doesn’t help, but this is also about new information coming to light, and how it moves from controversial theory to accepted practice. This process usually takes years, so this is actually moving quite fast.

    The problems with using ventilators are well known and well documented, but the problems with not using them are also well known, so I can understand how this new thinking generates controversy.

    There have been some big improvements in non-invasive ventilation methods over the past ten-fifteen years.

  7. SysATI says:
    @Thomasina

    It is true that Hydroxychloroquine + Azithromycin looks like a good treatement IN THE EARLY STAGES… If it’s too late and the person is already in the advanced stages of covid, they are absolutely useless…

    At least that is Dr Raoult is saying…

    So it is not a solution if there isn’t an early diagnosis, which means tests, tests and more tests…

  8. Jmaie says:
    @botazefa

    Isn’t it obviously more likely that the ventilator simply failed to save you?

    It is not. Ventilators increase the pressure inside the lungs and can damage the alveoli. At this point you’ve permanently lost the ability to transfer oxygen into you bloodstream.

    A doctor of my acquaintance is transfusing patients with oxygenated blood (similar to dialysis) with good results.

  9. botazefa says:

    It is not. Ventilators increase the pressure inside the lungs and can damage the alveoli. At this point you’ve permanently lost the ability to transfer oxygen into you bloodstream.

    A doctor of my acquaintance is transfusing patients with oxygenated blood (similar to dialysis) with good results.

    Yes, ventilators use positive pressure. A person is put on a vent because he or she is in respiratory failure and will otherwise die. The result is not a permanent inability to oxygenate the blood, as you claim.

    Ventilators aren’t some some sort of optional covid-19 treatment.

    What you said about transfusing oxygenated blood is absolute nonsense. The only thing remotely like what you are talking about is ecmo.

    • Replies: @JasonT
    , @Emily
  10. JasonT says:
    @botazefa

    You don’t have the slightest clue what you are talking about.

    • Agree: Biff
    • Replies: @botazefa
  11. You’re late. I already introduced this. Nobody noticed.

  12. botazefa says:
    @JasonT

    You don’t have the slightest clue what you are talking about.

    I am a Respiratory Therapist. I have intubated people and put them on ventilators.

    • Replies: @Brás Cubas
    , @Magyar
  13. @botazefa

    I am a Respiratory Therapist. I have intubated people and put them on ventilators.

    Yes, that might explain your ardor in defense of that procedure.

  14. Magyar says:
    @botazefa

    Ventilators can indeed have iatrogenic effects ie they can and do kill people.

  15. Ccrn says:

    @botazefa maybe they are talking about permissive hypercapnia ? Perhaps we are blowing off too much co2.

  16. Emily says:
    @botazefa

    What you said about transfusing oxygenated blood is absolute nonsense.

    Really?
    https://www.dailymail.co.uk/health/article-8217879/Two-coronavirus-patients-saved-experimental-blood-treatment.html
    Think again!

    • Replies: @botazefa
  17. botazefa says:
    @Emily

    That article is about ecmo, which I mentioned in my original comment. ECMO is a heart lung machine. It continually adds oxygen to blood circulating through it and removes carbon dioxide. It’s a stretch to call it a transfusion, though I see that’s what the headline you linked says.

    I guess in this example we are both right. In all honesty, though, you’ll never hear a medical professional refer to ecmo as an ‘oxygenated blood transfusion.’ ECMO is not a simple process like a transfusion is.

  18. @Brás Cubas

    Did Shabbos Goy Johnson even have Corona (a cold) or was it more celebrity hype by the Elite to push for more controls and vaccines.

  19. I wondered whether it still would make sense to comment on this article, after all this time since it has been published. No one will probably read it. And I am not an expert on this subject, so I may just be talking nonsense.

    After some consideration, I decided to do it anyway. The author will read it, and that may do some good (though he is apparently not an expert either).

    There is a video in the internet of someone who identifies herself as a friend of a New York nurse. She narrates in the video some things she says her nurse friend told her about how patients of Covid-19 were being treated in the hospital where she worked. Among several other things, she said that patients were being intubated because non-invasive oxygenation disseminated the virus and doctors were afraid of being infected themselves (apparently invasive ventilation is a closed system and NIV an open one; these may not be the exact words). I was concerned at the time, but the video didn’t strike me as an authentic one so I didn’t think much of it.

    But I kept reading about that problem of virus dissemination in hospitals in connection to non invasive oxygenation techniques. I came to the conclusion that, regardless of the authenticity of the video I referred to, there was a high probability that the situation she described was a real one in some places.

    Today I happened upon an article published yesterday which states that indeed this is a real situation. Its title is nearly identical to yours:

    COVID19: Are ventilators killing people?
    https://off-guardian.org/2020/05/06/covid19-are-ventilators-killing-people/

    I will reproduce below the relevant excerpt from that article:

    The question arises: If ventilators are not recommended for respiratory infections, may do more damage than they prevent and are less effective than non-invasive ventilation, why are they being so widely used?

    Well, one possible reason is that, according to the WHO guidelines, non-invasive ventilation could contribute to the spread of the virus via “aerosolisation”. This is repeated in guidelines from the CDC, ECDC and other national institutions.

    The UK’s NHS goes one step further again, with their March 19th protocol actually calling mechanical ventilation the “preferred” option over non-invasive ventilation or other oxygen therapies.

    This leaves wide open the possibility that hospitals are using treatments known to cause harm, simply to avoid the hypothetical spread of the virus.

    • Replies: @Brás Cubas
  20. @Brás Cubas

    I have a few remarks to make in regards to that OffGuardian piece (COVID19: Are ventilators killing people? https://off-guardian.org/2020/05/06/covid19-are-ventilators-killing-people/)

    In regards to the following excerpt from that piece:

    Well, one possible reason is that, according to the WHO guidelines, non-invasive ventilation could contribute to the spread of the virus via “aerosolisation”. This is repeated in guidelines from the CDC, ECDC and other national institutions.

    The UK’s NHS goes one step further again, with their March 19th protocol actually calling mechanical ventilation the “preferred” option over non-invasive ventilation or other oxygen therapies.

    Nothing in that excerpt is true and I am sorry I shared it without first checking the linked documents’ contents. None of the cited guidelines or protocols says anything remotely similar to what this author (Kit Knightly is his name, real or pseudonymous) claims it does.

    I will leave you the links to those documents (which are lost on the quote above), so you can check for yourself.

    Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations
    https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations

    Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings
    https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

    Infection prevention and control and preparedness for COVID-19 in healthcare settings
    https://www.ecdc.europa.eu/sites/default/files/documents/Infection-prevention-control-for-the-care-of-patients-with-2019-nCoV-healthcare-settings_update-31-March-2020.pdf

    Clinical management of persons admitted to hospital with suspected COVID-19 infection
    https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/clinical-management-of-persons-admitted-to-hospita-v1-19-march-2020.pdf

    I am still very concerned about “the possibility that hospitals are using treatments known to cause harm, simply to avoid the hypothetical spread of the virus”, particularly in Brazil, which is where I live. There are several Brazilian news stories which strengthen my suspicions. But the WHO, CDC, ECDC, and NHS have nothing to do with it. Again, I am sorry I trusted what should not have been trusted.

  21. Vanhooten says:

    As a former respiratory therapist and educator – many years ago – I put more people on a ventilator than I took off. Intubation can result in localized necrosis to the trachea, as well as the most common result, infection. This was particularly due then to Pseudomonas aeruginosa and other opportunistic bacterial agents – back then most antibiotics worked. Today’s hospital-acquired infections are much more dangerous and difficult to treat, particularity in a immunodeficient or elderly patient.

    In a case more than a few days duration, secondary infections followed, especially urinary ones. Also atelectasis, or lung collapse, was common in long-term patients, followed by therapies such as chest tubes, which also led to infections.

    A tremendous responsibility falls on the bedside caregiver whether they be a technician, therapist, or nurse to maintain aseptic technique and pulmonary maintenance on a 24-7 basis. With today’s staffing shortages and availability of trained personnel, this may be difficult except in level 1 hospitals.

    I agree that placing a patient on ventilator is a last ditch decision to possibly save the patient’s life…but the odds aren’t good. Back then, we didn’t have CPAP (continuous positive airway pressure), like the common bedside sleep apnea machine. With supplemental oxygen, it can be an effective option to mechanical ventilation, which often required sedation and further reduces the patients’ odds.

    I’m an old man now, and would never be put on a ventilator willingly. The odds will never be in my favor…

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