The terrible tale of the ventilators

Entire supply chains were changed. Kind-hearted souls rushed to engineer solutions. Politicians frantically called for tens of thousands of ventilators.

All for naught. Because ventilators appear to be a death sentence for COVID 19 patients. Now, thousands sit idle, another example of the knee jerk panic, heavily politicized reactions that have been the real plague behind this disease.

New research shows that 88% of those on a ventilator die. Would they have lived not being on a ventilator? Many may have survived without being ventilated. We may never know.

Ventilators are used to treat common forms of pneumonia. Here’s the problem: COVID 19 is not a normal pneumonia. It’s something quite different.

COVID 19 does not lead to to a “typical” acute respiratory disorder There is this perplexing thing about Covid-19: Many patients have blood oxygen levels at near death levels. But they are not gasping for air, and their hearts aren’t showing the normal signs of distress.

In COVID 19 patients, the air sacs of the lungs become filled with fluid. This prohibits the oxygen transfer to blood when the machine is pumping. The pressure from the ventilator may actually damage the lungs.

If the air sacs of the lungs are so gummy that they can’t absorb oxygen, a ventilator’s high pressure could cause damage, according to an influential letter last week written by Italian and German ARDS experts in the American Journal of Respiratory and Critical Care Medicine.

A Lancet article published in late February indicated the high mortality rate for those on ventilators. Subsequent studies all pointed to severe mortality.

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New York ER Cameron Kyle-Sidell stepped down because he didn’t want to follow the hospital’s ventilator protocol (and has a fascinating series of tweets to read if you’re so inclined).

Sidell, in an interview, outlined the problem:

  • When he initially started treating patients, he was under the impression, as most doctors were, that he was going to be treating acute respiratory distress syndrome (ARDS).
  • As he started to treat these patients, he witnessed things that were unusual. Normally, a patients who is talking in full sentences does not complain of overt shortness of breath, with oxygen saturation in the high 70s (below 85 is considered life-threatening)
  • In short, it appears more like a high-altitude sickness, or pulmonary (lung) sickness (the bends, which divers get coming up to quickly).. The patient, even with low oxygen levels, continues to be able to talk and has a normal presentation.
  • It turned out ventilators were actually the wrong method of handling the problem.
  • He ran into a great deal of resistance and morally, couldn’t keep putting people on ventilators, so he stepped down from the ICU and went back to the ER.

And worse, the recovery from being on machine ventilation is long and rough.

Thankfully doctors are realizing this and coming up with new solutions.

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