Governments all over the world are scrambling to get their hands on ventilators. And that includes the government of Victoria which has 1000 ventilators, and has now ordered 2000 more to treat an expected surge in coronavirus patients. But are ventilators really the magic bullet in the case of this coronavirus? Or, are they in some cases, doing far more harm than good.
A New York City physician named Cameron Kyle-Sidell has posted a video on YouTube, pleading for health practitioners to recognize that COVID-19 is not a pneumonia-like disease at all. It’s an oxygen deprivation condition, and the use of ventilators may be doing more harm than good with some patients.
COVID-19 lung disease, as far as I can see, is not a pneumonia . Rather, it appears as if some kind of viral-induced disease most resembling high altitude sickness. Is it as if tens of thousands of my fellow New Yorkers are on a plane at 30,000 feet as the cabin pressure is slowly being let out. These patients are slowly being starved of oxygen.
Kyle-Sidell argues that ventilators, in some cases, may be doing far more harm than good because from what he is seeing COVID 19 is an oxygen deprivation condition.
In short, I believe we are treating the wrong disease, and I fear that this misguided treatment will lead to a tremendous amount of harm to a great number of people in a very short time… I feel compelled to give this information out.
When we treat people with ARDS, we typically use ventilators to treat respiratory failure. But these patients’ muscles work fine. I fear that if we are using a false paradigm to treat a new disease, then the method that we program [into] the ventilator, one based on respiratory failure as opposed to oxygen failure, that this method being widely adopted … aims to increase pressure on the lungs in order to open them up, is actually doing more harm than good, and that the pressure we are providing to lungs, we may be providing to lungs that cannot take it. And that the ARDS that we are seeing, may be nothing more than lung injury caused by the ventilator.
The real disease appears to cause oxygen deprivation in victims, not pneumonia.
This is critically important for all the obvious reasons, and it raises huge questions about the origins of the coronavirus and whether there is some additional external factor beyond the virus that may be causing a combined effect that results in severe oxygen deprivation.
For the sake of Boris Johnson, the Prime Minister of the United Kingdom, presently a patient in an intensive care unit in London, we hope his physicians take note.
These are machines used for artificial ventilation. The respiratory support of a very ill patient is achieved by positive pressure ventilation through an endotracheal tube – a plastic tube inserted via the mouth leading into the trachea. This is a very serious intervention which results in changes to normal physiology such as an increase in intrathoracic pressure leading to reduced venous blood return and a fall in cardiac output followed by lowered blood pressure and decreased renal output. There are changes in the lung such as reduced compliance caused by difficulties in the distribution of the gas and atelectasis (collapse of lung) and other factors. Other changes to normal physiology include: decreased urinary output, respiratory alkalosis, salt and water retention, obstruction to lymphatic drainage which predisposes to infection. To assist with ventilation and maximise oxygen delivery most patients are heavily sedated and have their muscles paralysed.
Cameron Kyle-Sidell is not alone in his concerns about the treatment of seriously ill COVID-19 patients and is joined by Luciano Gattinoni, MD of the Medical University of Göttingen in Germany, who also makes the case that protocol-driven ventilator use for these patients could be doing more harm than good. Gattinoni also argues against the current ventilation protocols for a condition that seems more like high-altitude pulmonary edema (HAPE).
Dr. Gattinoni noted that COVID-19 patients in intensive care units in northern Italy had an atypical ARDS presentation with severe hypoxemia and well-preserved lung gas volume. He and his colleagues suggested that instead of high positive end-expiratory pressure (PEEP), physicians should consider the lowest possible PEEP and gentle ventilation-practicing patience to “buy time with minimum additional damage.”
Gattinoni and his colleagues argue for setting ventilators on physiological findings rather than using standard protocols. He stated that there is that one centre in Europe which has had a 0% mortality rate among COVID-19 ICU patients when using this approach, compared with a 60% mortality rate at a nearby hospital using conventional approach to ventilation.
More caution re the rights and wrongs of ventilation comes from researcher David Crowe
This leads to the use of invasive oxygenation, high dose corticosteroids, antiviral drugs and more. In this case, some populations (e.g. in China) are older and sicker than the general population and much less able to withstand aggressive treatment. After the SARS panic had subsided doctors reviewed the evidence, and it showed that these treatments were often ineffective, and all had serious side effects, such as persistent neurologic deficit, joint replacements, scarring, pain and liver disease. As well as higher mortality.
So do we need to buy 1000’s of new ventilators? Or 30,000 as the Governor of New York recently called for. Time will tell.