#OverUseOfVentilators; #MisuseOfVentilators; #Covid19Patients
Germany, Apr 17 (Canadian-Media): The current protocol for immediately placing COVID-19 patients with alarmingly low levels of oxygen on mechanical ventilators, a standard practice for Acute Respiratory Distress Syndrome (ARDS), actually could cause harm to some COVID-19 patients, said a world-renowned Italian intensive care specialist Luciano Gattinoni in his paper published this week in the journal Intensive Care Medicine, media reports said.
Luciano Gattinoni. Image credit: Twitter
"A standard treatment cannot be applied to an un-standard disease," said Gattinoni.
Similar concerns have been expressed by doctors in New York state and elsewhere about putting patients on ventilators too soon and with the pressure too high.
Many doctors have begun to delay their use, after a death rate of 80 percent for people who go on ventilator was reported by New York authorities.
Gattinoni said patients with normal looking lungs but low oxygen are at risk of lung injury from the ventilators, where pressure from the air damages the thin air sacs that exchange oxygen with the blood.
In the early 1980s Gattinoni gained recognition for placing patients with certain respiratory problems in prone position, on their stomachs, to improve their oxygenation.
Although, this technique was first met with ridicule, it soon began to be widely adopted.
Gattinoni's paper was called "a game changer" by Marco Garrone, an emergency doctor at the Mauriziano Hospital in Turin, Italy.
"We started with a one-size-fits-all attitude, which didn't pay off," Garrone said of the practice of putting patients on ventilators right away, only to see their conditions deteriorate. "Now we try to delay intubation as much as possible."
This has led Garrone, emergency department to use non-invasive ventilation — different ways of getting oxygen into patients' lungs without force, such as a mask or a nasal cannula.
This helps people in the early stages of the disease to inhale enough oxygen without damaging their lungs.
However, the head of critical care at Toronto's University Health Network and Mount Sinai Hospital, warns against drawing any firm conclusions from Gattinoni's paper.
Niall Ferguson, site-lead at Toronto General Hospital, also says without any data to back it up, it should be recognized at this point, as mostly a theory.
Ferguson also agrees that for doctors, less experienced with the the use of ventilators are challenged, when pulled into a crisis situation.
Garrone said it's when ICU units get overwhelmed that the risk of misuse of ventilators is highest.
"I think there is a balance to be had between finding something that's simple and widely applicable versus trying to still personalize things for each patient," said Ferguson.