3 ms·

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 th

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.

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.