How Effective are Ventilators?

4 April 2020. Updated 21 April 2020.

We have zero success for patients who were intubated. Our thinking is changing to postpone intubation to as long as possible, to prevent mechanical injury from the ventilator. These patients tolerate arterial hypoxia surprisingly well. Natural course seems to be the best.

New York City doctor, EVMS Medical Group, April 15th 2020

One rationale for the imposition of extreme social distancing measures is so that we can “flatten the peak”, thereby buying the NHS time to increase its emergency surge capacity. In time, the argument goes, we can begin to relax these measures when the NHS has acquired more vital equipment for treating COVID-19 patients, such as ventilators. To that end, the Government launched a campaign to encourage British manufacturers to start making ventilators – a corona version of the ‘Dig for Victory‘ campaign launched in 1942.

But what if ventilators aren’t much good at saving the lives of patients critically ill with COVID-19? Depressingly, the evidence so far suggests they’re not. According to a report from the Intensive Care National Audit and Research Center (ICNARC), 66.3% of ventilated patients with COVID-19 died – and that is lower than the rate suggested by early data out of Wuhan, which showed 97% of ventilated patients succumbing to the disease.

The brutal logic here is that if hospitals cannot do much to save critically ill Covid patients, why go to such lengths to prevent the NHS becoming overwhelmed? On the other hand, this could also be an argument for prolonging the lockdown after the NHS has increased its surge capacity to cope with an increase in the number of Covid patients because it will mean a rise in infections will result in a corresponding rise in the number of deaths, with the NHS being unable to mitigate that even if the number of infections remains within capacity. Like so many bits of data throw up by this crisis, this one can be made use of by lockdown sceptics and lockdown advocates.

Further Reading

Clinical course and mortality risk of severe COVID-19‘, Paul Weiss, David R Murdoch, The Lancet, March 17th 2020

Ventilators aren’t a panacea for a pandemic like coronavirus‘ by Matt Strauss, The Spectator, April 4th 2020

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Dr Jennine Morgan
Dr Jennine Morgan
1 month ago

Doctors have reported a “ground glass appearance on Chest Xrays & no physical signs of pneumonia in patients with assumed Covid infection, despite severe breathlessness. This is more akin to altitude sickness & it would seem that red blood cells infected with the virus become damaged & haemoglobin fails to combine with oxygen. Thus patients are starved of oxygen leading to multi organ failure. Treatment with Hydroxychloroquine +zinc + azithromycin has seen rapid reversal of respiratory symptoms, within 3 hours. Uncontrolled trials have shown very high success rate. Hydroxychloroquine has a known mechanism of action. It facilitates uptake of Zinc into cells & Zinc interferes with RNA replicase, which stops the viral material from being replicated & spread.

eastberks44
eastberks44
1 month ago

Today’s ventilators work by cutting into the patient’s neck to insert a tube into the windpipe, which means the patient has to be anaesthetised. So when being put on it, you have to face the possibility and risk that you may never wake up.

So if I had to be put on a ventilator it would be this modern, compact version of the wartime Iron Lung:-

https://www.theengineer.co.uk/exovent-covid-19-ventilator/

Because it sucks. Literally. It’s the nearest thing to natural breathing for someone who can’t breathe naturally.

No one knows if it would keep me alive any longer than the usual sort. But if I had only a few days to live, I would much rather spend them being conscious, lucid, able to speak, eat and drink, and put my affairs in order.

mpatten
mpatten
1 month ago

I started working as a Consultant Anaesthetist with an Interest in Critical Care in 1998 at that time our hospital had 5 ITU beds ( Level 3) and had no form of kidney support (haemofiltration/dialysis). Over time we increased the number of beds to 7 ITU beds / 12 HDU beds (Level 2) and got some haemofiltration machines to provide kidney support. There were frequently times where our resources were stretched and difficult decisions had to be made about the appropriateness of admitting a patient to one of the beds. We also had to make decisions about withdrawing life sustaining treatment when the patient was not responding/improving. I always accepted that the resources were finite and that I had a part to play in managing how best to use the scarce resource of critical care.

Our patients were some of the sickest in the hospital and our mortality rate ran between 20-25%. A number of patients that survived critical care did not survive to leave the hospital. I stopped working in critical care when I became Medical Director in 2012. I did not return to critical care when I came back to clinical work but continued to work as an anaesthetist in the operating theatres.

Declaration of Interest: I am convinced I have had covid-19. I had all the classic symptoms, although I was not tested. I had two weeks off work.

When I returned to work the hospital had dramatically increased it’s critical care capacity. This was achieved by shutting down practically all planned/elective operations in theatres, transferring the anaesthetic machines (they can act as ventilators) into two wards to create a new critical care unit, then using the staff that would normally work in the operating theatres in the new unit, backed up by a small number of experienced critical care staff.

I have enormous admiration for these staff and how they have coped, particularly with the days of peak demand with a high number of patients, and they have achieved one of the key aims that no patient needing respiratory support has not had access to a ventilator.

However, we may have inadvertently created a position where because there is the extra capacity nearly every patient gets a chance on a ventilator, despite the increasing evidence that most of them will not survive invasive ventilation. Just because we can put a patient on a ventilator it does not always make it appropriate. I accept that the results are better for non-invasive ventilation. Some of the patients have comorbidities that also make them less likely to survive. Kidney support is also added in because a lot of the patients develop kidney failure which again increases mortality. There is a huge amount of resources going in to save a sadly small number of lives.

Our hospital has effectively become a series of covid-19 wards with a large critical care unit alongside. There are empty wards, which is practically unheard of, normally.

While our operating theatre staff help cover the enlarged critical care unit we cannot go back to planned elective operating. Will they have to stay there in case there is a second wave of cases? We are continuing some urgent cancer cases at a local private hospital. However, I am concerned that there is a great deal of morbidity and eventually mortality that will carry on in the wider community until we can get back to something resembling a ‘normal’ hospital.

During the pandemic flu of 1969/70, critical care was in its infancy and there was very little access to invasive ventilators and kidney support machines. Patients died then that may have survived in the present day. However, at what cost are we creating the survivors of this pandemic?

Sascha Anya
Sascha Anya
1 month ago
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