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Text / Su Guanmi
The CCP (Wuhan pneumonia, COVID-19) epidemic continues to erupt worldwide. In countries and regions where the epidemic is severe, not only is there a severe shortage of medical personnel, but the number of respirators that can sustain the lives of critically ill patients is far from sufficient. A New York doctor found that the mortality rate for critically intubated patients is as high as 80%, and he believes that the use of a respirator may not be effective and even cause further damage. That’s right?
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In severely affected areas, due to insufficient medical resources, doctors continue to face the painful choice of “who should be saved.” There are even older patients who give up their hope of survival and give the respirator to others.
The respirator is a substitute for the patient’s own breathing when the patient is unable to breathe due to lung failure to overcome oxygen deprivation and seek time for treatment.
But according to the Associated Press report, New York officials noted that at least 80% of patients were still dying after using the respirator. New York is currently the most severely affected area in the United States, with more than 200,000 confirmed cases and more than 10,000 deaths.
The report summarizes the opinions of various doctors and believes that there are these reasons for using a respirator to save the patient:
● For patients with respiratory failure, the mortality rate is high;
● The side effects of the respirator can further damage the patient’s lungs;
● Currently, there is no effective antiviral medication, and it is difficult to quickly relieve respiratory failure.
In response, Su Yifeng, a thoracic intensive care doctor in Taiwan, explained that people generally breathe under negative pressure. As you inhale, the chest cavity expands and turns into negative pressure, allowing air to flow. However, the respirator breathes with positive pressure, using pressure to send gas to the lungs, causing the alveoli to physically expand, which can cause physical injury. In general, patients who have no problems with their lungs can use the lungs to cause lung damage, so the shorter the breath, the better.
Under normal circumstances, the amount of breathing apparatus and oxygen supply should not be too high. If the pumping is too strong, the physical damage to the lungs will increase; If the oxygen is too high, the alveolar cells will have oxidative pressure, causing inflammation of the alveoli. Therefore, it is necessary to adapt to the needs of the patients.
But patients with severe pneumonia will give 80% to 90%, even 100% pure oxygen. Su Yifeng noted that because the patient’s alveolar exchange function is already very poor at this time, a high concentration of oxygen must be administered. However, because the lungs are very fragile at this time, it is easy to cause more severe inflammation due to too high an inspiratory volume.
Not only that, CCP pneumonia currently has no effective treatment, and it is difficult to give patients the proper antiviral medications to reduce the virus and decrease symptoms of infection. This delays the patient’s respiratory failure for 3-4 weeks, even longer, and the use of the respirator takes longer.
Not only New York, other regions and countries face the same difficulties in treating critically ill patients.
High mortality rate in severely affected areas is not due to respirator
Currently, some New York doctors believe that the respirator is not necessarily effective for patients with the CCP virus, and most patients with a respirator have not recovered. New York doctors have tried to cut down on respirator use. Su Yifeng believes this is highly inappropriate: “Serious pneumonia patients do not use a respirator, and the death rate should be 100%.”
Under normal circumstances, patients with severe respiratory distress are intubated and treated with a respirator, and the death rate is approximately 20 to 50%. Why is the death rate so much higher in affected areas like New York? There are 2 reasons:
1. The respirator is very scarce and the patient cannot be intubated in time.
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The life-saving clinical code of the critical care physician is that when critically ill patients still have a chance of survival, they must intubate and use the respirator early to fight for the treatment time of the patients. In areas where the epidemic is very severe, Su Yifeng believes that, in the absence of a respirator, it is speculated that many patients can wait until hypoxia is very severe before intubation. But at this time the patient’s cardiopulmonary function has been extremely depleted, and even multiple organ failure, at this point intubation is too late and the death rate is naturally high.
2. Lack of critical professionals, the effect of treatment is greatly reduced.
When the epidemic is severe, both the respirator and the room can be quickly built and constructed, but it is difficult to rapidly increase the number of medical personnel who can operate the respirator professionally. A full respiratory intensive care team needs these human resources: experienced thoracic critical care physicians, anesthesiologists, respiratory therapists, and fully trained nurses.
Patients with severe pneumonia need professional medical attention. However, due to a lack of medical care, many doctors in unrelated departments must also go to the front line to care for patients, such as radiologists, psychiatrists, and even unskilled medical students. But the patched medical team will find many problems in treatment:
● The intubation time is selected too late or the intubation action is slow, which prolongs the patient’s hypoxia time.
● Lack of experience adjusting and configuring the respirator, including the amount and pressure of air supply and the type of air supply.
● Insufficient understanding of the respiratory care required during the treatment process, including how to administer antibiotics and perform special therapies.
● If the patient has not improved, it is difficult to judge what to do next.
Taking the thoracic intensive care specialist as an example, Su Yifeng introduced that it takes 7 years to train a doctor: 1 year as a resident doctor, 3 years of training in internal medicine, 2 years of thoracic training and 1 year of training in thoracic critical care. . At the same time, we must add years of clinical experience to perfect, and these experiences cannot be fast, not to mention that the license is not available.
Therefore, it is difficult for unskilled medical teams to achieve the level of treatment required during the treatment process, and it is natural to predict high mortality.
In contrast, Taiwan has better control over the current epidemic situation, and medical resources are still available. The intubation rate is 7% to 8%, so the number of deaths is low, with a total of only 6 people.
(Transferred from The Epoch Times / Editor in charge: Zhang Xinyan)
URL of this article: https://www.ntdtv.com/b5/2020/04/16/a102824384.html
