New York’s largest hospital system is conducting a major analysis of the use of ventilators when treating coronavirus patients at the height of the epidemic – with concerns that too much reliance on machines could cost lives.
For many COVID-19 sufferers, combining a mechanical ventilator is a death sentence. Two-thirds of patients at Northwell health facilities attached to ventilators died in early March and early April, and mortality rates at other hospitals were similar.
At the beginning of the infection, health officials were concerned that there would be a shortage of ventilators to cover COVID patients with severe breathing and lung problems. But the discussion in the medical community turned to whether overuse and contributing to high mortality.
“One theory is that if you put some patients on a ventilator, they can irritate the lungs. This is a theory, ”Northwell’s senior vice president and associate physician-in-chief, Dr. Thomas McGinn, told The Post.
Northwell – which operates Lexox Hill, Long Island Jewish and Staten Island University hospitals and other regional hospitals – is reviewing a portion of the 12,000 coronavirus patients treated in March and early April, about 2,000 of whom were placed on ventilators.
“We are trying to do a retrospective review. The debate is, should we have tried other non-aggressive interventions in the first place? A big question is, do we delay patients or put them on a ventilator? McGinn said.
McKeown said Northwell’s doctors experimented with alternative or aggressive ventilation, such as providing oxygen to patients with a tight-fitting face or nasal clip rather than a mechanical ventilator with an aggressive tube inserted into the throat.
But there are no easy answers. If a patient’s respiratory virus is blown into the air, an alternative procedure can increase the risk of spreading the virus to hospital staff, he said.
“This puts patients and nurses and respiratory therapists at risk of questionable benefit,” McGinn said.
McGinn said the study will examine patients who have been on ventilators for a few days and those who have come for a long time.
Younger COVID patients who do not have other serious underlying problems are sufficient to remove the ventilators in just a few days, while elderly patients with more serious heart or kidney problems are too sick to take off the respiratory apparatus.
One study found that all Northwell Covid patients treated in early March and early April had at least one baseline in addition to the virus. The average age is 63 years.
Researchers found that of the more than 5,449 patients who were treated at Northwell hospitals between March 1 and April 5, 37 percent had developed severe kidney injury or kidney failure. Of those with kidney problems, 35 percent died.
McGinn said the goal is to learn from the findings and improve clinical practice and techniques for treating COVID patients going forward.