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)
- 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
- Causes (EVALI, Trauma, Pneumonia, Aspiration, Sepsis, blood transfusions)
- Low paO2 to FiO2 ratio
- Bilateral infiltrates on CXR or CT scan (GGO)
- keys to managing ARDS patients
- LTVV and PEEP
- What is PEEP?
- Risk of PEEP
- Prone positioning
- 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
- What is ECMO?
- 30% risk of bleeding
- 5% risk of thromboembolism
- Only 250 centers
- Not accepting transfers
- Patient and/or family decides on wishes
- 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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