Most COVID-19 Patients, who need a breathing tube, meaning mechanical ventilation, do not live. Based on a recent study, only 14% live. To understand why this is, let’s take a look at what intubation and mechanical ventilation really means, and we also have to understand what COVID-19 does to the lungs.

When we intubate someone, meaning put a breathing tube down into their upper airway, and have that person on a ventilator, meaning mechanical ventilation, there are only 4 main reasons why we do that. So it’s sometimes its one, two, three, or all 4 or these reasons.

  • Indications for Intubation (at least one of following)
    • Hypoxia
    • Hypercapnia
    • Increased WOB
    • Reduced level of consciousness
  • COVID-19 patients who are intubated (mortality rate)
    • COVID-19 patients die because it triggers a chaotic inflammatory response within the lungs
    • ARDS
      • Causes (EVALI, Trauma, Pneumonia, Aspiration, Sepsis, blood transfusions)
      • Diagnosis
        • Low paO2 to FiO2 ratio
        • Bilateral infiltrates on CXR or CT scan (GGO)
        • Non-cardiogenic
      • keys to managing ARDS patients
        • LTVV and PEEP
        • What is PEEP?
        • Risk of PEEP
        • Prone positioning
        • Steroids
        • Paralysis
        • Different mechanical ventilation strategies
    • average length of mech ventilation: 17 days
    • mortality rate for those who required intubation: 86% (based on a study done a few weeks ago in the Lancet)
  • Course for intubated patients
    • Get better, extubate
    • Don’t get better, trach
    • Don’t get better, extubate and die in peace/comfort
    • Get worse and die with a breathing tube in, connected to the ventilator
  • ECMO
    • What is ECMO?
    • 30% risk of bleeding
    • 5% risk of thromboembolism
    • Only 250 centers
    • Not accepting transfers
    • Patient and/or family decides on wishes
    • DNI
    • DNR
    • CPR for COVID-19 patients?
    • Teams determining code status based on SOFA scores

Watch the full video to get the whole details properly:

Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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