3 ms·

> Doctors eventually realized invasive ventilation was a death sentence. Do you have a source that ventilation itself worsens outcomes, and isn't just correlat

> Doctors eventually realized invasive ventilation was a death sentence. Do you have a source that ventilation itself worsens outcomes, and isn't just correlated with already poor-performing patients?

baskire 6y ago
Here’s a good summary of some findings. “ Among the 2,634 patients for whom outcomes were known, the overall death rate was 21%, but it rose to 88% for those who received mechanical ventilation, the Northwell Health COVID-19 Research Consortium reported.” “ Ventilators are typically used only when patients are extremely ill, so experts believe that between 40% and 50% of patients die after going on ventilation, regardless of the underlying illness.” https://www.webmd.com/lung/news/20200422/most-covid-19-patients-placed-on-ventilators-died-new-york-study-shows https://www.webmd.com/lung/news/20200422/most-covid-19-patie...
- tylerhou 6y ago
  1. This is from April. 2. The cited study only measures outcomes and does not claim that ventilators worsen patient outcomes. Covid patients who are hospitalized have a higher rate of death [citation needed]. Does that mean hospitals kill Covid patients? [1] https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184
  - baskire 6y ago
    Don’t disagree. However there’s some evidence that ventilators might not have been the best treatment. The data itself is incomplete in the linked study.
  - robbiep 6y ago
    There is some weird sort of logic with 2. For example, when I worked in Cairns (cape York Australia, which serves a massive area with a large indigenous population), aboriginals have a belief that people going to the hospital go there to die (because people who have been sick enough to go to hospital... die). So yes, hospitals kill covid patients, because patients sick enough to need to go to hospital are sick enough to die. I know you’re kind of writing in jest and looking for sources but the fact remains that admittance to ICU (when I did my ICU term, at least in Australia and at least when I did it - my brother is an ICU trainee and I raised this number with him and he said it’s lower than that now, here) carries an all source mortality risk of 30%. 30% of those who are wheeled through the doors go out in a bag. To relate this to COVID, generally ventilators don’t cause an increase in mortality just because you are on one. This was a surprising finding during the early days. It is also contrary to what we find in influenza patients, where it is usually life saving when a patient gets too tired to breathe in their own but still has enough good lung function to be able to respire with their lungs (the alternative being ECMO, or artificial blood gas exchange). I’m on mobile and it’s late so am not at liberty to pull up the research but I recall the consensus being that there was a contradiction: patients who were sedated and ventilated were being so done on the basis of a rapid deterioration in o2 sats; but generally we’re still alert and potentially orientated. It was quickly found that prone positioning (putting a patient on their front to get more gas exchange to the apexes of their lungs) could keep then unventilated and they did better - a lesson learned pretty quickly as regions of Italy and the UK ran out of ventilators
tehjoker 6y ago
The problem was that for a healthy person, ventilation just moves your lung physiologically, but for very sick patients parts of their lungs are like inflamed tissue paper so the forced inflation could cause problems.
- tylerhou 6y ago
  Ventilators are highly complicated pieces of medical grade machinery that cost upwards of $50,000. They are not just regular old pumps with tubes attached. "Forced ventilation" does not properly describe the delicate nature of their operation. If used properly by trained medical professionals, they are better than the alternative — no ventilation at all.
  - tehjoker 6y ago
    The perspective I share is one that comes from a doctor that works in the ICU (not me). I am not against ventilation, but there are attendant risks when treating COVID-19 specifically.
taxicabjesus 6y ago
Lots of sources. This one is from April 23, 2020: Special Report: As virus advances, doctors rethink rush to ventilate - https://www.reuters.com/article/us-health-coronavirus-ventilators-specia/special-report-as-virus-advances-doctors-rethink-rush-to-ventilate-idUSKCN2251PE https://www.reuters.com/article/us-health-coronavirus-ventil... This is not even a good source, just something that I linked to in a previous comment here. Remember how the governments were rushing Ventilator production, then those efforts got memory-holed? This was because the professionals realized they shouldn't try to ventilate every COVID-19 patient in their hospital.
- tylerhou 6y ago
  From your article: > The picture is partial and evolving, but it suggests people with COVID-19 who have been intubated have had, at least in the early stages of the pandemic, a higher rate of death than other patients on ventilators who have conditions such as bacterial pneumonia or collapsed lungs. > This is not proof that ventilators have hastened death: The link between intubation and death rates needs further study, doctors say. A summary: we shouldn't ventilate everyone because ventilation has risks (like all medical treatments). Nowhere does the article claim that ventilation is a "death sentence" as you originally claimed.
robbiep 6y ago
This is correct and well established; prone positioning and non invasive ventilation was shown fairly early on to have a significant survival benefit. Not that I agree with the rest of the OP’s attempt at making some sort of statement

baskire 6y ago

Here’s a good summary of some findings. “ Among the 2,634 patients for whom outcomes were known, the overall death rate was 21%, but it rose to 88% for those who received mechanical ventilation, the Northwell Health COVID-19 Research Consortium reported.” “ Ventilators are typically used only when patients are extremely ill, so experts believe that between 40% and 50% of patients die after going on ventilation, regardless of the underlying illness.” https://www.webmd.com/lung/news/20200422/most-covid-19-patients-placed-on-ventilators-died-new-york-study-shows https://www.webmd.com/lung/news/20200422/most-covid-19-patie...

tylerhou 6y ago
1. This is from April. 2. The cited study only measures outcomes and does not claim that ventilators worsen patient outcomes. Covid patients who are hospitalized have a higher rate of death [citation needed]. Does that mean hospitals kill Covid patients? [1] https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184
- baskire 6y ago
  Don’t disagree. However there’s some evidence that ventilators might not have been the best treatment. The data itself is incomplete in the linked study.
- robbiep 6y ago
  There is some weird sort of logic with 2. For example, when I worked in Cairns (cape York Australia, which serves a massive area with a large indigenous population), aboriginals have a belief that people going to the hospital go there to die (because people who have been sick enough to go to hospital... die). So yes, hospitals kill covid patients, because patients sick enough to need to go to hospital are sick enough to die. I know you’re kind of writing in jest and looking for sources but the fact remains that admittance to ICU (when I did my ICU term, at least in Australia and at least when I did it - my brother is an ICU trainee and I raised this number with him and he said it’s lower than that now, here) carries an all source mortality risk of 30%. 30% of those who are wheeled through the doors go out in a bag. To relate this to COVID, generally ventilators don’t cause an increase in mortality just because you are on one. This was a surprising finding during the early days. It is also contrary to what we find in influenza patients, where it is usually life saving when a patient gets too tired to breathe in their own but still has enough good lung function to be able to respire with their lungs (the alternative being ECMO, or artificial blood gas exchange). I’m on mobile and it’s late so am not at liberty to pull up the research but I recall the consensus being that there was a contradiction: patients who were sedated and ventilated were being so done on the basis of a rapid deterioration in o2 sats; but generally we’re still alert and potentially orientated. It was quickly found that prone positioning (putting a patient on their front to get more gas exchange to the apexes of their lungs) could keep then unventilated and they did better - a lesson learned pretty quickly as regions of Italy and the UK ran out of ventilators

tehjoker 6y ago

The problem was that for a healthy person, ventilation just moves your lung physiologically, but for very sick patients parts of their lungs are like inflamed tissue paper so the forced inflation could cause problems.

tylerhou 6y ago
Ventilators are highly complicated pieces of medical grade machinery that cost upwards of $50,000. They are not just regular old pumps with tubes attached. "Forced ventilation" does not properly describe the delicate nature of their operation. If used properly by trained medical professionals, they are better than the alternative — no ventilation at all.
- tehjoker 6y ago
  The perspective I share is one that comes from a doctor that works in the ICU (not me). I am not against ventilation, but there are attendant risks when treating COVID-19 specifically.

taxicabjesus 6y ago

Lots of sources. This one is from April 23, 2020: Special Report: As virus advances, doctors rethink rush to ventilate - https://www.reuters.com/article/us-health-coronavirus-ventilators-specia/special-report-as-virus-advances-doctors-rethink-rush-to-ventilate-idUSKCN2251PE https://www.reuters.com/article/us-health-coronavirus-ventil... This is not even a good source, just something that I linked to in a previous comment here. Remember how the governments were rushing Ventilator production, then those efforts got memory-holed? This was because the professionals realized they shouldn't try to ventilate every COVID-19 patient in their hospital.

tylerhou 6y ago
From your article: > The picture is partial and evolving, but it suggests people with COVID-19 who have been intubated have had, at least in the early stages of the pandemic, a higher rate of death than other patients on ventilators who have conditions such as bacterial pneumonia or collapsed lungs. > This is not proof that ventilators have hastened death: The link between intubation and death rates needs further study, doctors say. A summary: we shouldn't ventilate everyone because ventilation has risks (like all medical treatments). Nowhere does the article claim that ventilation is a "death sentence" as you originally claimed.

robbiep 6y ago

This is correct and well established; prone positioning and non invasive ventilation was shown fairly early on to have a significant survival benefit. Not that I agree with the rest of the OP’s attempt at making some sort of statement