The mortality rate of ventilated COVID-19 patients could be 80% [1]. I get that we don’t want people to die, but at what point is this standard intervention just cruel? It feels like we should have a serious discussion about palliative care.
One of the Guardian articles mentioned in passing that, in normal times, hospitals put people on ventilators that maybe they shouldn't from an ethical perspective (I think the doctor's exact words were that he wouldn't want an 85 year old relative of his to be put on one) and that this was the first thing they'd have to give up on in a serious Covid-19 outbreak.
yea but we dont have any data as to why? is it because some number of them were over/under anesthetized? is it because of the triage criteria?
I do agree that palliative care is a critical discussion because of the mortality rates for the very elderly-- some people are just to frail to ever have good outcomes from intibation.
by the way, the critically interesting thing in that piece from the lancet is that the rational for discouraging non invasive respiration is a lack of good masks and negative pressure rooms. These are problems where I think there has been an historical lack of imagination and are ripe for some novel solutions.
He was intubated because it was necessary during the transportation and the surgery. They said that they didn't want my dad stop breathing while being transported if anything happened during the trip. Plus, they said the surgery causes a lot of trauma and I think they were afraid the breathing would stop.
A few days after the surgery, he couldn't even breath on his own: MRI showed that parts of his brain were damaged. At that time, I think it's more sympathetic to let him go instead of making his life depending on a ventilating machine for the rest of his life.
No. Some people survive and doctors have a moral and ethical obligation to not throw their hands up in the air. Furthermore, without informed consent or advance directives, it's unfair and unethical to play god.
The circumstances of this situation is that ventilated COVID patients often drown in their own plasma, get bacterial pneumonia or their lungs are irreparably destroyed. Like ECMO, this sort of ventilation is a hail mary procedure to try to salvage patients.
Even COVID survivors with mild symptoms, they may have reduced lung capacity due to lung damage.. and that may well be permanent. I suspect lung transplant lists will be backlogged the world over due to this pandemic.
Ventilation is not a very cruel intervention, especially since you will almost certainly be sedated. I've been intubated a few times, and I'd much rather take this than for example CPR which regularly breaks ribs.
It’s not a cakewalk for the elderly. I think some patients would want to remain communicative with loved ones rather than fade away unconscious over weeks.
We should be upfront about the odds of a full recovery and allow room for thoughtful discussion around patients’ wishes. The frenzied environment of ICUs during a pandemic isn’t conducive to this, so we need to be deliberate and talk about it as a country. The “job one is saving lives” rhetoric may not be best for patients and their families.
I’ve seen nurses and doctors on Twitter mention that “every patient needs to be fixated, as they experience a feeling of drowning or asphyxiation and try to remove the tube”
I’m not sure if that experience is caused by the ventilation, or by the disease and misattributed. In any case, I’ve decided not to get infected by this bug. And if I fail at that, I might even consider a living will excluding ventilation.
Are they intubating COVID-19 patients without general anesthesia? I've been in the hospital a month due to pneumonia and have been intubated 3 times. The second and third times they did intubation and extubation all under general.
The first time they put some kind of special tube in under general. When I came to 3 days later there was no ventilator, and the end of the tube was in my throat. It felt like a rectangular block. They extubated me while I was awake and immediately put me on high flow oxygen. They would've intubated me on the spot if I couldn't breathe. Never felt a gagging sensation in this instance.
it's a natural reaction to having a thing down your throat. i woke up in the ICU once with a tube in. my wrists were bound down so I wouldn't pull it out (which i would have, in my newly awakened stupor). once awake and lucid i was fine to have hands freed.
It is true, if you are conscious you will try to remove the tube (self-extubation), as it makes you gag. But that means that sedation is too low, which could be because they don't have time to monitor everybody.
And/or they have shitty monitoring equipment made by legacy players in an industry that needs disrupting. I mean yes there are staffing issues as well, but both can be true.