Northwell Health probing ventilator use amid high coronavirus death rate

New York’s largest hospital system is conducting a sweeping analysis of its use of ventilators while treating coronavirus patients during the peak of the pandemic.
The study comes as experts have raised concerns that an over-reliance on the machines may have actually cost lives.
For so many sick COVID-19 patients, getting attached to a mechanical ventilator was a death sentence. More than two-thirds of the patients in Northwell Health facilities hooked to ventilators died in March and early April and the fatality rate was similar at other hospitals.
At the beginning of the pandemic, health officials were worried whether there would be a shortage of ventilators to intubate COVID patients with serious breathing and lung problems. But then discussion in the medical community turned to whether the machines were being overused and possibly contributing to a higher death rate.
“One theory is if you put some patients on a ventilator, you might irritate the lungs more. That’s a theory we’re looking at,” Dr. Thomas McGinn, Northwell’s senior vice president and deputy physician-in-chief, told The Post.
Northwell — which runs Lenox Hill, Long Island Jewish and Staten Island University hospitals, as well as other regional hospitals — is examining a cohort of 12,000 coronavirus patients it treated in March and early April, including about 2,000 who were placed on ventilators.
“We’re trying to do a retrospective review. The debate is, should we have tried other non-invasive interventions in the first place? A big question is, can you delay putting patients on a ventilator or never put them on?” McGinn said.
McGinn said Northwell medics did experiment with alternative or non-invasive ventilation, such as delivering oxygen to patients through a tight-fitting face or nasal clip, rather than a mechanical ventilator with invasive tube inserted down the throat.
But there are no easy answers. The alternative mechanism provides more of a risk of spreading the virus to hospital staffers if a patient’s breath spews the virus into the air, he said.
“It puts the nurses and respiratory therapists at risk and provide a questionable benefit to the patients,” said McGinn.
McGinn also said the study will look at cases of patients who were on ventilators for just a few days as well as those who were on for an extended period.
He said younger COVID patients without other serious underlying problems tended to get well enough to be taken off ventilators in just a few days, while older patients with more serious heart or kidney problems tended to be too sick to be taken off the breathing machines.
But McGinn emphasized that ventilators are used as a last resort for people who can’t breath.
“Vents don’t cause deaths. They save lives. If we didn’t put them on a vent they would all die,” he said.
“Question we are asking is, `what’s best approach.’”One study found that nearly all of the Northwell COVID patients treated in March and early April had at least one underlying condition in addition to the virus. The average age was 63.
Researchers also found that 37 percent of the more than 5,449 patients treated at Northwell hospitals from March 1 to April 5 developed acute kidney injury or kidney failure. Of those with kidney problems, 35 percent died.
The goal, McGinn said, is to learn from the findings and try to improve medical practice and techniques for treating COVID patients going forward.
https://nypost.com/2020/05/29/northwell-health-probing-use-of-ventilators-for-covid-patients/