Clinical Update: Most patients require a ventilator due to respiratory failure, which happens when the body is unable to: 1) exhale enough carbon dioxide or 2) breathe in sufficient oxygen. In any ICU, there’s usually a mix of these patients. But #COVID19 patients are different:
With nearly a month of experience, we’ve seen that COVID patients almost exclusively end up on ventilators due to a lack of oxygen NOT an excess of CO2 (hypercarbic respiratory failure). We’ve been able to delay, and in many cases avoid, a ventilator with the following approach:
Patients with #coronavirus who are hypoxic (oxygen saturation < 93%) on 6 liters of supplemental oxygen are placed on a non-rebreather. If hypoxia persists, patients are moved to negative pressure room, and high-flow oxygen is used (up to 60 liters).
This buys time, avoids dangers associated with emergent intubation, and in many cases obviates need for a ventilator. Formal protocol is now in development.
Note: protective equipment changes with high-flow oxygen; caregivers wear an impermeable gown, N95, face shield, and hair net. Note: We continue to observe that #coronavirus patients with profound hypoxia experience no symptoms.
The silver lining is two-fold: we are conserving ventilators and the generation young doctors who are training in this environment are going to be incredible.
