Some top doctors on the front lines treating COVID-19 patients say that many of them could be effectively treated with less invasive respiratory support than that provided by ventilators, a new report said Wednesday.
If they are right, putting patients on ventilators could offer little help to many and could even be harmful to some of them, according to STAT, a respected health care website.
The doctors have treated many patients whose blood oxygen levels were so low they should have been dead, but they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of shutting down from lack of oxygen.
The critical care physicians fighting the spreading pandemic suspect that blood levels of oxygen, which for decades have been used to determine the level of help patients with pneumonia and other respiratory ailments, might be misleading when it comes to COVID-19
As a result, more doctors are concerned about the use of intubation and mechanical ventilators, a shortage of which still plagues many hospitals and health care facilities across the US, with states struggling to find more and the federal government not having enough to go around.
The experts argue that more patients could benefit from simpler, less invasive respiratory support, such as the breathing masks used to treat sleep apnea, at least at the beginning and maybe until they recover.
“I think we may indeed be able to support a subset of these patients” with less invasive breathing support, Sohan Japa, an internal medicine physician at Boston’s Brigham and Women’s Hospital, told STAT.
“I think we have to be more nuanced about who we intubate.”
This doesn’t mean that ventilators are not needed during the pandemic, which has killed nearly 13,000 Americans.
But as doctors learn more about the virus, they might be able to substitute simpler and more widely available devices.
Still, many doctors are urging caution while trying the less invasive approaches.
“Most hospitals, including ours, are using simpler, noninvasive strategies first,” including the apnea devices, said Greg Martin, a critical care physician at Emory University School of Medicine and president-elect of the Society of Critical Care Medicine.
“It doesn’t require sedation and the patient [can remain conscious and] can participate in his care. But if the oxygen saturation gets too low you can achieve more oxygen delivery with a mechanical ventilator.”
But because in some patients, blood-oxygen levels fall to hardly-ever-seen levels, doctors are still intubating them sooner.
The problem, critical care physician Cameron Kyle-Sidell told Medscape this week, is that because American physicians had never seen COVID-19 before February, they are basing decisions on conditions that may not be good guides, the website reported.
“It’s hard to switch tracks when the train is going a million miles an hour,” said Kyle-Sidell, who works at a Maimonides Medical Center in Brooklyn.
“This may be an entirely new disease,” he said, suggesting that ventilator protocols developed for other medical conditions might not be the right guidelines as the mortality rate for patients put on ventilators is high.
Kyle-Sidell also said in a video this week that turning the pressure up on ventilators can damage peoples’ lungs.
“We are putting breathing tubes in people and putting them on ventilators and dialing up the pressure to open up their lungs,” he said.
“I’ve talked to doctors all around the country and it is becoming increasingly clear that the pressure we’re providing may be hurting their lungs, that it is highly likely that the high pressures we’re using are damaging the lungs of the patients we are putting the breathing tubes in,” he said in the 2-minute video.