Ventilator for COVID - Do Ventilators Save COVID Patients Lives?

Ventilators are not a cure but instead are a form of life support.
Most COVID Patients, who need a breathing tube, meaning mechanical ventilation, do not live. Based on a recent study, only 14% live. To understand why this is, let’s look at what intubation and mechanical ventilation really mean, and we also have to understand what COVID does to the lungs.

When we intubate someone, meaning put a breathing tube down into their upper airway, and have that person on a ventilator, meaning mechanical ventilation, there are only 4 main reasons we do that. So it’s sometimes one, two, three, or all 4 of these reasons.

1. Indications for Intubation (at least one of the following)
a. Hypoxia
b. Hypercapnia
c. Increased WOB
d. Reduced level of consciousness

2. COVID patients who are intubated (mortality rate)
a. COVID patients die because it triggers a chaotic inflammatory response within the lungs
b. ARDS
i. Causes (EVALI, Trauma, Pneumonia, Aspiration, Sepsis, blood transfusions)
ii. Diagnosis
1. Low paO2 to FiO2 ratio
2. Bilateral infiltrates on CXR or CT scan (GGO)

3. Non-cardiogenic
iii. keys to managing ARDS patients
1. LTVV and PEEP
2. What is PEEP?
3. Risk of PEEP
4. Prone positioning
5. Steroids
6. Paralysis
7. Different mechanical ventilation strategies
c. the average length of mech ventilation: 17 days
d. the mortality rate for those who required intubation: 86% (based on a study done a few weeks ago in the Lancet)

3. Course for intubated patients
a. Get better, extubate
b. Don’t get better, trach
c. Don’t get better, extubate, and die in peace/comfort
d. Get worse and die with a breathing tube in, connected to the ventilator

4. ECMO
a. What is ECMO?
b. 30% risk of bleeding
c. 5% risk of thromboembolism
d. Only 250 centers
, e. Not accepting transfers

5. DNI/DNR
a. The patient and/or family decide on wishes
b. DNI
c. DNR
d. CPR for COVID patients?
e. Teams determining code status based on SOFA scores

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Doctor Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine
Website: https://doctormikehansen.com/
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