Ventilators should be used sparingly for COVID-19 patients, researchers warn

Adopting a new playbook for deciding when to ventilate COVID-19 patients and using ventilators for these patients less often could help reduce the death rate among coronavirus patients on ventilators, a new review suggests.

The review, published in the American Journal of Tropical Medicine and Hygiene, and reported by STAT News, summarizes current guidance on best practices for providing ventilatory support, with a focus on resource-limited settings. The death of COVID-19 patients on ventilators is now more than 50 percent.

The authors write that invasive mechanical ventilation should be used for COVID-19 patients struggling to breathe. But patients with hypoxemia, or low blood oxygen levels, should not be rushed onto a ventilator "because hypoxemia is often remarkably well-tolerated," in COVID-19 patients, they said.

Unlike in patients with other forms of pneumonia or sepsis — where low blood oxygen levels cause the patient to gasp for breath and limits their ability to speak — COVID-19 patients with low blood oxygen levels do not show as many signs of respiratory distress and are even able to speak in full sentences, according to STAT.

The authors also write that COVID-19 affects patients' lungs differently than other causes of severe pneumonia or acute respiratory distress syndrome. Many COVID-19 patients develop a thick coating in their lungs that limits their ability to take in mechanically delivered oxygen, STAT reports.

Damaged areas and healthy tissue can sit side by side in the lungs of COVID-19 patients, they said. Delivering oxygen-enriched air to the healthy tissue at high pressure and in large volumes can cause further damage, such as leaks, swelling and inflammation, the researchers said.

"Invasive ventilation can be lifesaving, but can also damage the lung," Marcus Schultz, MD, Phd, a professor at Amsterdam University Medical Centers and a study author, told STAT.


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