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The artificial ventilation method is now used in extreme cases due to the high mortality of patients.
In Ukraine, the death rate among patients with COVID-19 coronavirus infection, who used ventilators, is 89 percent, Ukrainian scientists calculated. The same figure was previously given by American researchers. Correspondent.net says what is the reason for such an impressive mortality rate in mechanical ventilation.
Ventilation alone carries risks
One of the main problems of the coronavirus pandemic is the catastrophic shortage of ventilators. COVID-19 predominantly affects the lower respiratory tract and in 20 percent of cases it penetrates deep into the lungs.
When the lungs themselves cannot inhale enough oxygen and exhale the accumulated carbon dioxide. According to statistics, about four percent of the total number of coronavirus patients require mechanical ventilation. But there are quite a few other situations that require mechanical ventilation, and this is not just lung damage, for example, weakness of the respiratory muscles.
The principle by which ventilators work is called positive pressure ventilation. They pump oxygenated air in and out of the lungs.
There are two types of mechanical ventilation: invasive and non-invasive. With non-invasive artificial respiration, a tight-fitting mask is placed on the patient’s face, through which air is delivered to the lungs by the ventilator. In this case, the person retains all the natural functions of the respiratory tract.
If this doesn’t help, use invasive ventilation. This means that an endotracheal tube is inserted into the windpipe through the mouth or nose, or a tracheostomy tube is inserted through an incision in the windpipe.
People connected to “fans” cannot speak, eat or drink: they have to be fed artificially through a tube. Invasive ventilation is both physically and psychologically painful, and patients are usually placed in an artificial coma with anesthesia.
If the standard version of ventilation does not help, the person can lie face down while continuing to ventilate the lungs (this is also suggested by the World Health Organization). So, apparently, the blood flow in the lungs is redistributed and the blood flows through those areas where oxygen can enter.
At the beginning of the pandemic, many critically ill patients received mechanical ventilation beforehand, but died anyway.
A large study published in late April found an exceptionally high death rate of 88 percent in and around New York City when mechanical fans are used.
At the same time, not in the case of COVID-19, between 40 and 50 percent of people with severe lung diseases that are connected to artificial lung ventilation die.
Later, rescuers abandoned mechanical ventilation as a standard procedure for coronavirus infection, as the view won that high-pressure mechanical ventilation in the lungs could do more harm than help.
As long as patients can breathe on their own, they receive oxygen without being attached to a breathing apparatus. Currently, intubation is considered a remedy only in an emergency. That is, patients who are already in extremely serious condition are connected to the device.
Methods to avoid being hooked up to a ventilator include turning the patient to different positions so that different parts of the lungs are better supplied with oxygen.
Some are experimenting with adding nitric oxide to the oxygen mix to improve circulation and delivery to the least affected areas of the lungs.
On March 2, the Institute of Mathematical Machines and Systems Problems of the National Academy of Sciences of Ukraine published a study saying that 89 percent of COVID-19 patients who were connected to ventilators died in Ukraine.
The average death rate among those hospitalized with COVID-19 in Ukraine was around 15 percent, while among those admitted to the intensive care unit, the death rate was 76 percent.
It is observed that since the beginning of the coronavirus epidemic in Ukraine, 8,446 people have been connected to ventilators, of which 7,479 have died.
It is no secret that intubation is associated with risks. In particular, it can damage the lungs, as well as bacteria that can enter the body, which can cause inflammation.
Patients on mechanical ventilation often develop sepsis, which is a secondary bacterial infection and is one of the most important problems in emergency treatment. Sepsis is becoming a major cause of mortality. In such a situation, it is important to prescribe antibiotics as soon as possible.
It is worth remembering that due to the thoughtless use of this group of drugs, humanity faces a serious challenge: resistance to antibiotics, which can set drugs back 100 years. More on this in the material Why is the use of antibiotics dangerous?
In July, German scientists published an analysis of ventilated patients. The average age was 68 years. The older the patients, the greater the likelihood of needing mechanical ventilation.
Among patients 60 to 69 years old, that was 24 percent, in the age group 70 to 79 years, 25 percent, and in the age group 18 to 59 years, only 15 percent.
Patients with comorbidities were more likely to require mechanical ventilation, an analysis from the AOK Research Institute, the German Interdisciplinary Association for Intensive Care and Emergency Medicine and the Technical University of Berlin showed.
Thus, 43 percent of the mechanically ventilated patients had cardiac arrhythmias, 39 percent had diabetes. Doctors suggest that this may be associated with the level of mortality in the device.
Scientists from the University of Minho in Portugal, as well as doctors from the Department of Internal Medicine at Radboud University Medical Center in the Netherlands, late last year found that 23 percent of ventilated patients have fungal infections of the lungs. , which increases the risk of death by a quarter.
Researchers have identified pulmonary aspergillosis in these patients, a disease caused by fungi of the genus Aspergillus. The reasons for the development of this pathology can be both mechanical damage and the consequences of drug therapy for COVID-19, scientists say.
This is due to the fact that people with coronavirus, as a rule, receive mechanical ventilation for one to two weeks, while patients with bacterial pneumonia only need to remain on ventilation for one or two days.
In early February 2021, an international team of researchers led by periodontists from Qatar University analyzed data from 568 COVID-19 patients and found that periodontitis, an inflammation of the tissues surrounding a tooth, was observed in 45 percent of intensive care patients.
After adjusting for other factors, it turned out that gum disease patients are 3.5 times more likely to end up in the intensive care unit, 4.5 times more likely to require mechanical ventilation, and 8.8 times more likely to end up in the intensive care unit. To die.
The researchers also drew attention to the biomarkers of inflammation in the patients’ bodies. Its level was much higher in those who suffered from periodontitis.
Scientists note that ventilated periodontitis patients can exhale oral bacteria, which then enter the lungs, the study authors fear. This additional infectious burden can only exacerbate the course of COVID-19.
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