4 ms·

The report that you cite of 25% mortality for COVID patients on a ventilator is in line with COVID causing ARDS. There is currently no reason to believe that it

The report that you cite of 25% mortality for COVID patients on a ventilator is in line with COVID causing ARDS. There is currently no reason to believe that it causes some fundamentally different process from other ARDS-inducing diseases. Our experience at MGH also puts severe COVID lung disease squarely into the ARDS category, and it responds to standard ARDS ventilation protocols[1]. Our mortality to date is shy of 20%. Data over anecdote. 1 = https://www.atsjournals.org/doi/abs/10.1164/rccm.202004-1163LE https://www.atsjournals.org/doi/abs/10.1164/rccm.202004-1163...

elliekelly 6y ago
> Our mortality to date is shy of 20%. Is that across all Covid patients? Or ventilated Covid patients?
- carbocation 6y ago
  Ventilated. I should clarify since my positioning of the citation may have been a bit weird - the data is in the linked paper.
nichohel 6y ago
Thanks for the link. In the paper I see no direct comparison between COVID response to ventilation vs ARDS response to ventilation, but I think I understand that you say the responses are similar, based on your experience. Am I getting that right? Also, of course, there is nothing in the paper comparing COVID invasive ventilation outcomes with, for example, oxygen and positioning treatment outcomes. So, interesting, but I don't think this qualifies as "data over anecdote". I take it you are a pulmonary or ER doctor. If so, can you comment on the widely circulated claim that high death rates on ventilators in NYC are likely in part attributable to very aggressive ventilation and/or reduced attention to ventilation settings due to extreme fear of exposure to the virus (tubes leading from patients to other rooms and the like)?
- carbocation 6y ago
  Because of the high volume of patients, those of us with more critical care experience were redeployed to newly created MICUs, but I am not a pulmonologist (details in profile). The high death rates in NYC that were published were attributable to a statistical error (failing to use adequate censoring of people still on ventilators). Note that the article has been updated with correctly censored numbers (hence 25%): https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184 Finally, we only intubate patients after maneuvers like awake proning fail, so it’s not something that is comparable.
  - ricardobeat 6y ago
    The study says ~25% died and ~70% remained at the hospital, shouldn't we assume that a percentage of those will also die and raise the final mortality figure?
    - nichohel 6y ago
      Yes, I would certainly think that. Especially since given the timing of the article those on ventilators when the article was written probably had been on the ventilators for longer times on average, which doesn't bode well for them. Apparently a follow-up study is coming. I looked for it and did not find it yet. The original paper is: https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184 My guess is that in the final analysis, NYC death figures for those on ventilators will be higher than they should have been (after adjusting for age etc.) The question then will be why. But the real question, I think, is whether the death rates were higher than they would have been with less aggressive ventilator use.
    - carbocation 6y ago
      Yes, I agree that seems likely. Because recovery seems slow (with and without ventilatory support), we won’t have a final accounting for quite some time. My point is more that the 85% number is considered an error and caused a correction in the published record.
thebigspacefuck 6y ago
From what I understood, with ARDS, it was necessary to medically induce a coma/paralysis and, in order to have highest chances of survival, required staff to monitor and posture patients every 8 hours. Even if ventilator supply was not a constraint, would there be other constraints caused by staffing that would limit effectiveness of ventilators? Note: I am NOT a doctor or involved in health or medicine in any way. My source for this information is this MedCram lecture on Youtube: https://www.youtube.com/watch?v=okg7uq_HrhQ https://www.youtube.com/watch?v=okg7uq_HrhQ
- carbocation 6y ago
  Staffing is definitely an issue as you point out, but what you’re describing is what would happen if we were to run into a capacity issue, which we likely would have without the lockdown but which we have not (at least, in MA).
scottlocklin 6y ago
> 25% mortality for COVID patients on a ventilator That sounds more like the typical result for ventilators.[1] I think it's more like 80% fatality on ventilators for this disease[2][3][4]. According to the published literature of course; I ain't that kind of doctor, but based on what is known, if someone comes near me with one of those things, well, they won't be a doctor for long either. [1] https://www.sciencedirect.com/science/article/abs/pii/S0531556516301401 https://www.sciencedirect.com/science/article/abs/pii/S05315... [2] https://www.thelancet.com/action/showPdf?pii=S0140-6736(20)30566-3 https://www.thelancet.com/action/showPdf?pii=S0140-6736(20)3... [3] https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184 [4] https://www.physiciansweekly.com/mortality-rate-of-covid-19-patients-on-ventilators/ https://www.physiciansweekly.com/mortality-rate-of-covid-19-...
- carbocation 6y ago
  One of the articles that you’re citing (#3) had a correction due to a statistical error and they are now citing a ~25% mortality, not dissimilar to our data. Theirs and ours may end up higher than they are now once the final patient is discharged, but the current US numbers are more like 20-25% mortality on ventilators at this point rather than 85%.
  - scottlocklin 6y ago
    Can you provide any evidence of this? I certainly don't see any in the literature, which I follow closely enough to keep notes on subjects like this.

elliekelly 6y ago

> Our mortality to date is shy of 20%. Is that across all Covid patients? Or ventilated Covid patients?

carbocation 6y ago
Ventilated. I should clarify since my positioning of the citation may have been a bit weird - the data is in the linked paper.

nichohel 6y ago

Thanks for the link. In the paper I see no direct comparison between COVID response to ventilation vs ARDS response to ventilation, but I think I understand that you say the responses are similar, based on your experience. Am I getting that right? Also, of course, there is nothing in the paper comparing COVID invasive ventilation outcomes with, for example, oxygen and positioning treatment outcomes. So, interesting, but I don't think this qualifies as "data over anecdote". I take it you are a pulmonary or ER doctor. If so, can you comment on the widely circulated claim that high death rates on ventilators in NYC are likely in part attributable to very aggressive ventilation and/or reduced attention to ventilation settings due to extreme fear of exposure to the virus (tubes leading from patients to other rooms and the like)?

carbocation 6y ago
Because of the high volume of patients, those of us with more critical care experience were redeployed to newly created MICUs, but I am not a pulmonologist (details in profile). The high death rates in NYC that were published were attributable to a statistical error (failing to use adequate censoring of people still on ventilators). Note that the article has been updated with correctly censored numbers (hence 25%): https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184 Finally, we only intubate patients after maneuvers like awake proning fail, so it’s not something that is comparable.
- ricardobeat 6y ago
  The study says ~25% died and ~70% remained at the hospital, shouldn't we assume that a percentage of those will also die and raise the final mortality figure?
  - nichohel 6y ago
    Yes, I would certainly think that. Especially since given the timing of the article those on ventilators when the article was written probably had been on the ventilators for longer times on average, which doesn't bode well for them. Apparently a follow-up study is coming. I looked for it and did not find it yet. The original paper is: https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184 My guess is that in the final analysis, NYC death figures for those on ventilators will be higher than they should have been (after adjusting for age etc.) The question then will be why. But the real question, I think, is whether the death rates were higher than they would have been with less aggressive ventilator use.
  - carbocation 6y ago
    Yes, I agree that seems likely. Because recovery seems slow (with and without ventilatory support), we won’t have a final accounting for quite some time. My point is more that the 85% number is considered an error and caused a correction in the published record.

thebigspacefuck 6y ago

From what I understood, with ARDS, it was necessary to medically induce a coma/paralysis and, in order to have highest chances of survival, required staff to monitor and posture patients every 8 hours. Even if ventilator supply was not a constraint, would there be other constraints caused by staffing that would limit effectiveness of ventilators? Note: I am NOT a doctor or involved in health or medicine in any way. My source for this information is this MedCram lecture on Youtube: https://www.youtube.com/watch?v=okg7uq_HrhQ https://www.youtube.com/watch?v=okg7uq_HrhQ

carbocation 6y ago
Staffing is definitely an issue as you point out, but what you’re describing is what would happen if we were to run into a capacity issue, which we likely would have without the lockdown but which we have not (at least, in MA).

scottlocklin 6y ago

> 25% mortality for COVID patients on a ventilator That sounds more like the typical result for ventilators.[1] I think it's more like 80% fatality on ventilators for this disease[2][3][4]. According to the published literature of course; I ain't that kind of doctor, but based on what is known, if someone comes near me with one of those things, well, they won't be a doctor for long either. [1] https://www.sciencedirect.com/science/article/abs/pii/S0531556516301401 https://www.sciencedirect.com/science/article/abs/pii/S05315... [2] https://www.thelancet.com/action/showPdf?pii=S0140-6736(20)30566-3 https://www.thelancet.com/action/showPdf?pii=S0140-6736(20)3... [3] https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184 [4] https://www.physiciansweekly.com/mortality-rate-of-covid-19-patients-on-ventilators/ https://www.physiciansweekly.com/mortality-rate-of-covid-19-...

carbocation 6y ago
One of the articles that you’re citing (#3) had a correction due to a statistical error and they are now citing a ~25% mortality, not dissimilar to our data. Theirs and ours may end up higher than they are now once the final patient is discharged, but the current US numbers are more like 20-25% mortality on ventilators at this point rather than 85%.
- scottlocklin 6y ago
  Can you provide any evidence of this? I certainly don't see any in the literature, which I follow closely enough to keep notes on subjects like this.