While ventilators have become a symbol of the fight against Covid-19, some doctors are having doubts as to whether the machines do more harm than good.
Many who go on a ventilator die, and those who survive likely will face ongoing breathing problems caused by either the machine or the damage done by the virus, USNews.com reported.
The problem is that the longer people are on ventilation, the more likely they are to suffer complications related to machine-assisted breathing, the report said.
Recognizing this, some intensive care units have started to delay putting a Covid-19 patient on a ventilator to the last possible moment, when it is truly a life-or-death decision, said Dr. Udit Chaddha, an interventional pulmonologist with Mount Sinai Hospital in New York City.
“There had been a tendency earlier on in the crisis for people to put patients on ventilators early, because patients were deteriorating very quickly,” Chaddha said. “That is something that most of us have stepped away from doing.
“We let these patients tolerate a little more hypoxia [oxygen deficiency]. We give them more oxygen. We don’t intubate them until they are truly in respiratory distress,” Chaddha said.
“If you do this correctly, if you put somebody on the ventilator when they need to be put on the ventilator and not prematurely, then the ventilator is the only option.”
Experts estimate that between 40% and 50% of patients die after going on ventilation, regardless of the underlying illness, the report said.
It’s too early to say if this is higher with Covid-19 patients, although some regions like New York report as many as 80% of people infected with the virus die after being placed on ventilation.
Dr. Steve Reynolds, medical director and critical care and infectious diseases specialist at New Westminster’s Royal Columbian Hospital in Canada, will launch this week what the hospital foundation is calling a first-ever study to collect data from Covid-19 patients on ventilators, CBC News reported.
The hope is the study could lead to new ideas about how best to use ventilators on Covid-19 patients, the report said.
“It’s a really key aspect,” Reynolds told reporters over streaming video. “I think people have heard a lot about ventilator shortages but it’s really key how … you deliver this mechanical ventilation.
“We can contribute to the global discussion on this.”
The lab, he said, has diagnostic tools that can provide real-time data about how different approaches to ventilator use, especially when it comes to ventilator pressure, impact patient outcomes.
The hope is to rapidly share this information with researchers around the world and patients’ doctors to develop new approaches for ventilator use, the report said.
Reynolds said doctors are finding Covid-19 patients’ lungs may behave somewhat differently than lungs afflicted with other diseases.
Viral pneumonia or a lung infection usually leads to “stiff” lungs, he explained, and ventilators treating those diseases use high pressure to keep the lungs open.
“We expect the lungs, when they’re inflamed and injured, to act a certain way and there’s indications that [Covid-19 patients’ lungs] actually act differently,” he said.
“Our regular way we manage these patients may not be optimal.”