DOCTORS EXPERIENCED IN COVID-19 TREATMENT RETHINK VENTILATOR USE
BERLIN— When he was diagnosed with the new coronavirus disease (COVID-19), physician Andre Bergmann wanted to be treated at the Bethanien hospital lung clinic in Moers in northwestern Germany because it was known for its reluctance to use mechanical ventilators.
But soon after entering the clinic, Bergmann said he struggled to breathe even with an oxygen mask and felt so sick the ventilator seemed inevitable.
Even so, his doctors never put him on a machine that would breathe for him. A week later, he was well enough to go home.
Shift in thinking
Bergmann’s case illustrates a shift in treatment protocols as doctors rethink when and how to use mechanical ventilators to treat severe sufferers of the disease—and in some cases whether to use them at all.
Machines to help people breathe have become the major weapon for medics fighting COVID-19 and governments around the world raced to build or buy ventilators as most hospitals said they were in critically short supply.
The US government set aside $2.9 billion for nearly 190,000 ventilators and forced automakers General Motors Co. and Ford Motor Co. to retool before US President Donald Trump said the United States was now “the king of ventilators.”
But most of the 30 doctors Reuters interviewed in China, Italy, Spain, Germany and the United States said they had become more sparing with the equipment as they gathered more knowledge of what COVID-19 does to the body.
Nearly all agreed that ventilators are vitally important and have helped save lives but many highlighted the risks from using the most invasive types of them—mechanical ventilators—too early or too frequently.
Doctors’ main concern is around mechanical ventilation, which involves putting tubes into patients’ airways to pump air in, a process known as intubation.
Those with severe oxygen shortages, or hypoxia, have generally been intubated and hooked up to a ventilator for up to two to three weeks, with at best a fifty-fifty chance of surviving, according to doctors interviewed by Reuters and recent medical research.
Empirical basis only
The picture is partial and evolving, but it suggests people with COVID-19 who have been intubated have had, at least in the early stages of the pandemic, a higher rate of death than other patients on ventilators.
This is not proof that ventilators have hastened death: The link between intubation and death rates needs further study, doctors say.
In China, 86 percent of 22 COVID-19 patients didn’t survive invasive ventilation at an intensive care unit (ICU) in Wuhan, according to a study published in The Lancet in February.
Normally, the paper said, patients with severe breathing problems have a 50-percent chance of survival.
A recent British study found two-thirds of COVID-19 patients put on mechanical ventilators ended up dying anyway, and a New York study found 88 percent of 320 mechanically ventilated COVID-19 patients died.
More recently, none of the eight patients who went on ventilators at the Abu Dhabi hospital had died as of April 9, a doctor there told Reuters.
And one ICU doctor at Emory University Hospital in Atlanta said he had had a “good” week when almost half the COVID-19 patients were successfully taken off the ventilator, when he had expected more to die.
In Germany, as patient Bergmann struggled to breathe, he said he was getting too desperate to care.
“There came a moment when it simply no longer mattered,” he told Reuters. “At one point I was so exhausted that I asked my doctor if I was going to get better. I was saying, if I had no children or partner then it would be easier just to be left in peace.”
Instead of putting Bergmann on a mechanical ventilator, the clinic gave him morphine and kept him on the oxygen mask.
He’s since tested free of the infection, but not fully recovered.
Without harm
The head of the clinic, Thomas Voshaar, a German pulmonologist, has argued strongly against early intubation of COVID-19 patients. Doctors including Voshaar worry about the risk that ventilators will damage patients’ lungs.
In the US state of Louisiana, doctors at the Ochsner Health saw an influx of people with signs of acute respiratory distress syndrome.
“Initially we were intubating fairly quickly on these patients as they began to have more respiratory distress,” said Robert Hart, the hospital’s chief medical officer. “Over time, what we learned is trying not to do that.”
Instead, Hart’s hospital tried other forms of ventilation using masks or thin nasal tubes, as Voshaar did with his German patient. “We seem to be seeing better results,” Hart said.