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I have heard concern from many doctors in the #COVID19 front lines about early intubation. It is telling that some are afraid to speak publicly. I am not an expert. But would like to relay the worry about interaction bias in this setting. #Foamed
One intensivist told me he saw a patient with clear-cut heart failure (pulmonary edema and pleural effusions and known LV dysfunction) intubated immed and placed on isolation. The patient had no C19 signs and stayed on the vent for days waiting for the negative test.
Here is a screenshot from another colleague: NIVPP means non-invasive methods for ventilation. The note is self explanatory.
The point about using resources is only one issue. It is not free to be on a vent for days. There can be atrophy of muscles (those needed to get off the vent), risk of infection, trauma to the lungs, delirium from sedatives.
When I get this infection and if I am teetering on the edge of intubation, please give me a chance to fly.
This is not meant to say we should not be intubating patients who need it. It is only to spread the word that experts on the frontlines have expressed reservation about seemingly well-meaning policies that could backfire.
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