An overwhelming majority of New York City COVID-19 patients who are put on ventilators die, leading doctors to reconsider whether the method of treatment is actually harmful for patients infected with the novel coronavirus, according to the Associated Press.
Why this matters: New York and other states have been desperate to obtain enough ventilators for the number of COVID-19 patients they expect to get. The belief has been that many people could potentially die if they don’t have access to a ventilator.
What’s actually happening: There is some evidence that the ventilators aren’t helping, and they could actually be causing harm due to the stress they put on a patients’ already compromised lungs.
Although experts say 40% to 50% of patients with severe respiratory distress die on ventilators, the numbers out of New York City are much higher — 80%. In China and the United Kingdom, the death rate for ventilator patients is also elevated.
But some health professionals have wondered whether ventilators might actually make matters worse in certain patients, perhaps by igniting or worsening a harmful immune system reaction.
That’s speculation. But experts do say ventilators can be damaging to a patient over time, as high-pressure oxygen is forced into the tiny air sacs in a patient’s lungs.
“We know that mechanical ventilation is not benign,” said Dr. Eddy Fan, an expert on respiratory treatment at Toronto General Hospital. “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.”
COVID-19 can lead to mild or no symptoms in many patients, but some suffer from serious respiratory distress caused by inflammation in the lungs. COVID-19 patients who do require ventilator support tend to be on those ventilators for much longer than a typical pneumonia patient, according to the AP.
Some physicians have observed that COVID-19 patients have shockingly low blood-oxygen levels — levels that would normally be fatal — even when they’re not struggling to breath or stay conscious. Which means blood-oxygen level, which is normally used in deciding whether to put a patient on a ventilator, might not be a reliable metric for the coronavirus.
“I think we have to be more nuanced about who we intubate,” Sohan Japa, an internal medicine physician at Boston’s Brigham and Women’s Hospital, said, according to STAT News.
What are the alternatives? New York City doctors are exploring a variety of treatment alternatives. In past weeks, very sick coronavirus patients have been immediately placed on ventilators. Now, some doctors are trying to use ventilators only as a last resort.
Some methods being attempted include having patients lie in different positions or providing oxygen other ways, such as through the nose.
“If we’re able to make them better without intubating them, they are more likely to have a better outcome — we think,” said Dr. Joseph Habboushe, an emergency medicine doctor who works in Manhattan, AP reported.