Some doctors move away from ventilators for virus patients | Health

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NEW YORK – As health officials around the world strive to get more ventilators to treat coronavirus patients, some doctors are giving up on breathing devices when they can.

The reason: some hospitals have reported unusually high death rates for ventilated coronavirus patients, and some doctors worry that the machines could harm some patients.

The evolution of treatments highlights the fact that doctors are still learning the best way to manage a virus that appeared only a few months ago. They rely on real-time anecdotal data amid a crush of patients and a shortage of basic supplies.

Mechanical ventilators push oxygen to patients with failing lungs. Using the machines involves sedating a patient and sticking a tube into the throat. Deaths in these sick patients are common regardless of the reason they need respiratory help.

In general, 40% to 50% of patients with severe respiratory distress die on ventilators, according to experts. But 80 percent or more of the coronavirus patients placed on New York machines have died, state and city officials said.

Higher than normal death rates have also been reported elsewhere in the United States, said Dr. Albert Rizzo, chief medical officer of the American Lung Association.

Similar reports have emerged from China and the United Kingdom. A UK report estimated the figure at 66%. A very small study in Wuhan, the Chinese city where the disease first appeared, found that 86% of people died.

The reason is not clear. This may be related to the type of form in which the patients were before they became infected. Or it could be related to how they got sick when they were put on the machines, according to some experts.

But some healthcare professionals have wondered if the respiratory system can make things worse in some patients, perhaps by triggering or worsening a harmful immune system reaction.

This is speculation. But experts say the ventilators can damage the patient over time, because high pressure oxygen is forced into the tiny air sacs of the patient’s lungs.

“We know that mechanical ventilation is not benign,” said Dr. Eddy Fan, respiratory treatment expert at Toronto General Hospital. “One of the most important discoveries in recent decades is that medical ventilation can make lung damage worse – we have to be careful about how we use it. “

The dangers can be mitigated by limiting the amount of pressure and the size of the breaths delivered by the machine, Fan said.

But some doctors say they try to keep patients out of the ventilators for as long as possible and that they are turning to other techniques instead.

Just a few weeks ago in New York, very sick coronavirus patients were routinely put on respirators to make them breathe, said Dr. Joseph Habboushe, an emergency room doctor who works in Manhattan hospitals.

But more and more, doctors are trying other measures first. One is to lie patients down in different positions – including the stomach – to allow different parts of the lung to ventilate better. Another is to give patients more oxygen through nasal tubes or other devices. Some doctors are experimenting with adding nitric oxide to the mixture to help improve blood circulation and oxygen in the least damaged parts of the lungs.

“If we are able to improve them without intubating them, they are more likely to have better results – we think,” said Habboushe.

He said these decisions are separate from concerns about the lack of available fans. But it’s also a concern, Habboushe added.

There are many reports that coronavirus patients tend to be ventilated for much longer than other types of patients, said Dr. William Schaffner, an infectious disease expert at Vanderbilt University.

Experts say that patients with bacterial pneumonia, for example, can be ventilated for a day or two at most. But it’s common for coronavirus patients to have been ventilated “seven days, 10 days, 15 days, and they die,” said New York Governor Andrew Cuomo, when asked about ventilator death rates during a press conference on Wednesday.

This is one reason to fear that the fans will not grow in sufficient numbers. Experts fear that as cases increase, doctors will be forced to make terrible decisions about who lives and who dies, as they will not have enough machines for every patient who needs them.

New York state health commissioner Dr. Howard Zucker said on Wednesday that authorities were looking into other possible therapies that could be given sooner, but added that “this is all experimental.”

The new virus is part of the coronavirus family which can cause colds and more serious illnesses. Health officials say it is mainly spread from droplets when an infected person coughs or sneezes. There is no proven drug treatment or vaccine for this.

Experts believe that most infected people suffer nothing worse than unpleasant but mild illnesses that can include fever and cough.

But about 20% – many of them elderly people or people weakened by chronic diseases – can become much sicker. They may have difficulty breathing and suffer from chest pain. Their lungs can become inflamed, causing a dangerous condition called acute respiratory distress syndrome. It is estimated that 3 to 4% may need fans.

“The ventilator is not therapeutic. It is a support measure while we wait for the patient’s body to recover, “said Dr. Roger Alvarez, pulmonologist at the University of Miami Health System in Florida.

Zachary Shemtob said he was “absolutely terrified” when he was told that her 44-year-old husband David was to be put on a ventilator at NYU Langone last month after being infected with the virus.

“Having to be ventilated can mean never getting off the ventilator,” he said.

Shemtob said the hospital had given no percentage of survival, but he felt it was essentially a set of coins. He didn’t look up the rates until after her husband breathed alone six days later.

“A draw was generous, it seems,” he said.

But Shemtob noted that the cases vary. Her husband is relatively young.

“David is living proof that they can really save lives and how incredibly important they are,” said Shemtob.

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Associated Press journalists Candice Choi and Jennifer Peltz in New York contributed to this report.

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The Associated Press’s Department of Health and Science is supported by the Department of Science Education at the Howard Hughes Medical Institute. The AP is solely responsible for all content.

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