Don't intubate too soon, NYC physician warns

Many physicians are starting to share clinical insights they learned while working on the frontlines of the COVID-19 pandemic in New York City, reports The New York Times.

Their insights into how they adapted care systems and clinical practices could offer valuable lessons for hospitals in states where COVID-19 has yet to peak.

Nicholas Caputo, MD, an emergency medicine physician at NYC Health + Hospitals/Lincoln, said the most important lesson he wished he and other physicians knew in early March was to not jump to intubation too quickly. 

Instead of immediately sedating patients with low oxygen levels and placing them on a ventilator, many New York City physicians are using other techniques to boost oxygen levels while patients are conscious. This includes a practice called proning, in which patients roll to their side or stomachs while receiving oxygen to open up their lungs.

Other physicians are using repurposed CPAP machines to increase oxygen levels or special pregnancy mattresses, which includes a cutout for their bellies, to ease the pressure on COVID-19 patients' stomachs and chests. 

New York now reports about 21 new intubations a day, down from about 300 daily in late March. 

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