Evidence Shows Nearly All N.Y. COVID Patients Die After Being Put on Ventilator
The largest analysis of hospitalized U.S. COVID-19 patients to date finds that most did not survive after being placed on a mechanical ventilator.
The study included the health records of 5,700 COVID-19 patients hospitalized between March 1 and April 4 at facilities overseen by Northwell Health, New York State’s largest health system.
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Among the 2,634 patients for whom outcomes were known, the overall death rate was 21%, but it rose to 88% for those who received mechanical ventilation, the Northwell Health COVID-19 Research Consortium reported.
The new findings “provide a crucial early insight into the front-line response to the COVID-19 outbreak in New York,” Dr. Kevin Tracey, president and CEO of the Feinstein Institutes for Medical Research, said in a Northwell Health news release.
The findings also add fuel to the notion that ventilators may sometimes do more harm than good for patients battling for life with severe COVID-19.
Mechanical ventilators work by pushing air into the lungs of critically ill patients who can no longer breathe well on their own. These patients must be sedated and have a tube stuck into their throat.
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Recognizing that complications from ventilator use can occur, some intensive care units (ICUs) have started to delay putting a COVID-19 patient on a ventilator until the last possible moment, when it is truly a life-or-death decision, said Dr. Udit Chaddha, an interventional pulmonologist with Mount Sinai Hospital in New York City.
“There had been a tendency earlier on in the crisis for people to put patients on ventilators early, because patients were deteriorating very quickly,” Chaddha said. “That is something that most of us have stepped away from doing.
“We let these patients tolerate a little more hypoxia [oxygen deficiency]. We give them more oxygen. We don’t intubate them until they are truly in respiratory distress,” Chaddha said. “If you do this correctly, if you put somebody on the ventilator when they need to be put on the ventilator and not prematurely, then the ventilator is the only option.”
Ventilators are typically used only when patients are extremely ill, so experts believe that between 40% and 50% of patients die after going on ventilation, regardless of the underlying illness.
These critically ill patients die because they are so sick from COVID-19 that they needed a ventilator to remain alive, not because the ventilator fatally harms them, said Dr. Hassan Khouli, chair of critical care medicine at the Cleveland Clinic in Ohio.
“I think for the most part it’s not related to the ventilator,” Khouli said. “They’re dying on the ventilator and not necessarily dying because of being on a ventilator.”
An 88% death rate is especially high, however.
Ventilators do have side effects. Because a machine is breathing for them, patients often experience…