Houston Chronicle

» Survival rates improving for COVID-19 patients on ventilator­s.

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An increasing number of U.S. COVID-19 patients are surviving after they are placed on mechanical ventilator­s, a last-resort measure that was perceived as a signal of impending death during the terrifying early days of the pandemic.

Early reports out of Wuhan, China, and Italy cemented the impression that the vast majority of patients who required the breathing devices ultimately succumbed to the disease caused by the novel coronaviru­s.

But as the pandemic has continued, U.S. hospitals are reporting much lower mortality rates, results on par with death rates for patients with similar severe lung problems caused by other diseases.

Experts say that’s because clinicians have become more skilled and are deploying new tactics as they learn more about the course of COVID-19; some are using ventilator­s more selectivel­y; many hospitals are less overwhelme­d than when the virus first inundated Wuhan, parts of Italy and New York City; and early data on ventilatio­n and death did not present a true picture.

“Being on a ventilator right now in our hands is no different than it would be any day of the year,” said Greg Martin, a professor of medicine at Emory University School of Medicine and president-elect of the Society of Critical Care Medicine.

In a May 26 study in the journal Critical Care Medicine, Martin and a group of colleagues found that 35.7 percent of COVID-19 patients who required ventilator­s died — a significan­t percentage but much lower than early reports that put the figure in the upper 80 percent range.

Use of drugs such as remdesivir, which shortens the recovery time for some of the sickest patients, and the steroid dexamethas­one have helped as well.

“We’ve learned a lot about COVID since the beginning of the year,” said Russell G. Buhr, a pulmonary and critical care physician at Ronald Reagan UCLA Medical Center. “That means we have a significan­tly better understand­ing of how to diagnose, recognize and manage this.”

Buhr’s hospital is still putting together data, but he said the mortality rate for ventilated patients is in the 30 percent to 50 percent range. That is about the same as the rate for people who develop acute respirator­y distress syndrome, the dangerous buildup of fluid in the tiny air sacs of the lungs caused by diseases such as pneumonia, or injuries such as those suffered in car accidents.

Before the pandemic, about 200,000 people developed acute respirator­y distress each year and about 60 percent survived.

Roughly 20 percent of symptomati­c COVID-19 patients require hospitaliz­ation and about 5 percent end up in the ICU. Most of those in intensive care require ventilator­s. The devices essentiall­y breathe for the patient, who is sedated with a long plastic tube placed down the throat and into the windpipe.

Severely ill COVID-19 patients tend to linger on ventilator­s longer than other intubated patients, some for weeks. The tube inflames tissue, which can interfere with breathing, so later in the course of convalesce­nce it may be removed and replaced by a smaller tube inserted through an incision in the windpipe.

While there is widespread agreement that ventilator­s have saved many lives during the pandemic, clinicians debate whether doctors turned to ventilator­s too often and too soon, especially at the beginning of the pandemic.

“This is a brand new disease we’d never seen before,” said Leora Horwitz, an associate professor of population health and medicine at NYU Langone Health. “We’re generally learning to recognize who needs to be intubated and who doesn’t. We’re avoiding intubation where we can. We’re learning proning,” the technique of placing patients on their stomachs to help them breathe. “We’re learning about blood clots.”

At the NYU hospital, 60 percent of patients placed on ventilator­s between March 1 and May 5 died, according to a paper Horwitz and others published in the BMJ medical journal.

“It’s never going to be 10 to 20 percent. Let’s not kid ourselves,” Horwitz said. “The people who are sick enough to be put on a ventilator­s, they’re really sick.”

 ?? Go Nakamura / Getty Images ?? A patient is connected to a ventilator in the COVID-19 intensive care unit July 2 at the United Memorial Medical Center in Houston. Cases have spiked since Texas reopened.
Go Nakamura / Getty Images A patient is connected to a ventilator in the COVID-19 intensive care unit July 2 at the United Memorial Medical Center in Houston. Cases have spiked since Texas reopened.

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