Doctors re-evaluate the use of mechanical respirators | Coronavirus

• The Ministry of Health announces the purchase of 4,500 more respirators
• ‘I turn off the respirators and help them die in peace’: ICU reports with patients with Covid-19

The clinic is known for its reluctance to place patients with shortness of breath on the machines that help the process, respirators, which generally involve inserting tubes into the patient’s throat.

The 48-year-old doctor, a father of two and an amateur triathlete, feared that a respirator was invasive and harmful.

However, shortly after his admission, he had difficulty breathing, even with an oxygen mask. The respirator was inevitable.

Still, the doctors never put him in a machine that could breathe for him. A week later, he was discharged.

Bergmann’s case illustrates a change in the front line in the fight against Covid-19. Doctors reevaluate the use of mechanical respirators to treat the effects of the disease and, in some cases, do not even use the devices.

Doctors initially intubated patients, but many of them are now exploring other options.

Machines to help people breathe have become the primary weapon of doctors fighting Covid-19,

Within weeks of the outbreak of the disease, governments around the world began buying the machines. Germany acquired 10,000, engineers from various countries are designing new models, the USA. USA They paid $ 2.9 billion in respirators and readjusted factories to produce: Donald Trump said his country had become the king of respirators.

However, as doctors better understood the effects of Covid-19 on the body, many of them began to use the machine less.

Reuters interviewed 30 doctors or medical professionals in countries such as China, Italy, Spain, Germany, and the United States.

Almost everyone agrees that respirators are vitally important and have helped save lives. At the same time, many of them emphasize the risks of using some types, such as mechanical respirators, too early or too often, or use monitored by non-specialists or in crowded hospitals.

Medical procedures evolved during the pandemic, and doctors better understand the disease, including medications that can be administered. The change in respirators has important implications.

There are different forms of pulmonary ventilation that use masks to help oxygenate the organ.

Mechanical ventilation, which involves putting tubes into patients’ airways to pump air, a process known as intubation, worries doctors.

Patients are sedated to prevent their respiratory muscles from fighting the machine.

Those facing severe oxygen starvation are often intubated and hooked up to a respirator for up to three weeks, with a 50% chance of survival, according to doctors interviewed by Reuters and recent medical research.

The picture is biased and evolving, but suggests that people with Covid-19 who were intubated had, at least in the early stages of the pandemic, a higher mortality rate than other ventilator patients with conditions such as bacterial pneumonia or lungs. in collapse

This is not proof that ventilators accelerated death: the link between intubation and death rates needs further study, doctors say.

In China, 22 patients with Covid-19 underwent invasive ventilation in an intensive care unit in Wuhan, the city where the pandemic began. The vast majority (86%) did not survive, describes a study published in The Lancet in February.

Generally, according to research, patients with severe respiratory problems have a 50% chance of survival. A recent British study found that two-thirds of Covid-19 patients placed on mechanical respirators ended up dying anyway, and a study in New York found that 88% of 320 mechanically ventilated Covid-19 patients had died.

Most recently, none of the eight patients who used ventilators at the Abu Dhabi hospital died on April 9, a doctor told Reuters. And an ICU doctor at Emory University Hospital in Atlanta said he had a “good” week in which nearly half of Covid-19 patients were successfully removed from the ventilator when they expected more deaths.

Experiences can vary dramatically. The average time a Covid-19 patient spent on a ventilator at five Scripps Health hospitals in San Diego, California, was just over a week, compared to two weeks at Hadassah Ein Kerem Medical Center in Jerusalem and three weeks. at the hospital. The Universiti Malaya Medical Center in the Malaysian capital Kuala Lumpur, doctors at the hospital said.

The patient who did not want to go to the ventilator.

Bergmann, the patient who did not want to use the respirator, said he was too desperate to worry when he was in trouble.

“There came a time when it just didn’t matter anymore,” 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 that if you didn’t have children or a partner, it would be easier to be at peace. ”

Instead of putting Bergmann on a mechanical respirator, the clinic gave him morphine and kept him in the oxygen mask. You are now free of the infection, but you are not fully recovered.

The head of the clinic, Thomas Voshaar, a German pulmonologist, argued strongly against early intubation of patients with Covid-19. Doctors, including Voshaar, are concerned about the risk of ventilators damaging patients’ lungs.

Doctors interviewed by Reuters agreed that mechanical respirators are crucial to saving lives, especially in severe cases, when patients suddenly deteriorate. This happens to some when the immune system kicks in, known as a “cytokine storm” of inflammation that can cause dangerously high blood pressure, lung damage, and eventual organ failure.

Covid-19 was compared to the 1918-19 Spanish influenza pandemic, which killed 50 million people worldwide. Now, as then, the disease is new, serious and spreading rapidly, exceeding the limits of public health and the medical knowledge necessary to combat it.

When coronavirus cases began to appear in Louisiana, doctors at the state’s largest hospital system, Ochsner Health, saw an influx of people with signs of acute respiratory distress syndrome. Patients with this syndrome have inflammation in the lungs, which can cause shortness of breath and rapid breathing.

“Initially, we quickly intubated these patients when they started having more respiratory problems,” said Robert Hart, medical director of the hospital system. “Over time, what we have learned is to try not to do that.”

Instead, the Hart hospital tried other forms of ventilation with masks or thin nasal tubes, as did Voshaar with his German patient. “It seems like we are seeing better results,” Hart said.