Pro­to­cols evolve as un­ex­pected symp­toms arise

Vancouver Sun - - NP - SHARON KIRKEY

It started in New York City, in the trenches in the bat­tle against COVID-19. Stressed doc­tors be­gan wor­ry­ing that the breath­ing tubes and pres­sures be­ing used to open up the tiny air sacs in the lungs of the crit­i­cally sick could be caus­ing worse harm.

Some are now ask­ing, can we stave off ven­ti­lat­ing some pa­tients, and in­crease the chances of peo­ple be­ing dis­charged from hos­pi­tal alive?

“In many ways, it’s dif­fer­ent than any­thing we have seen be­fore,” Dr. James Dow­nar, a spe­cial­ist in crit­i­cal care and pal­lia­tive care said Thurs­day from in­side an ICU at The Ot­tawa Hos­pi­tal ded­i­cated to crit­i­cally ill COVID-19 pa­tients. On Thurs­day, the unit was full.

The pan­demic virus seems not only to af­fect the lungs, mak­ing them stiff and in­flamed, but other parts of the body as well, in­clud­ing the heart. It’s not clear if it’s a di­rect ef­fect of the virus on the heart that’s caus­ing heart fail­ure in some cases, or if it’s be­cause the virus is play­ing with the body’s co­ag­u­la­tion sys­tem, in­creas­ing the risk of blood clots.

It’s dif­fer­ent in an­other way, too: In a phe­nom­e­non re­ported in the U.S., as well as Italy and, now, Canada, some pa­tients with se­vere COVID-19 are ar­riv­ing in hos­pi­tal with such low blood oxy­gen lev­els they should be gasp­ing for breath, un­able to speak in full sen­tences, dis­ori­ented and barely con­scious.

Ex­cept they’re not in any sort of dis­tress, or very lit­tle dis­tress. They’re talk­ing. They’re lu­cid. It’s not the clas­sic acute res­pi­ra­tory dis­tress syn­drome doc­tors are used to see­ing, and that most guide­lines rec­om­mend doc­tors treat as such.

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