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I’ve seen some get better quickly. They act like good old bacterial pneumonia. Others take longer. We talk to families about tracheostomies and long term ventilation. They make progress but they will have long term complications from their journey.
There is however a subset. They seem to improve initially, but despite everything we do they deteriorate after a week on the ventilator. No matter what we do their lungs get stiffer and stiffer. Instead of healing, their lungs are replaced be scar tissue.
We search for hidden infections, scan them for blood clots, look for strange drug reactions and autoimmune disease. Over the ensuing weeks, their hearts start to fail from the tremendous work of pushing blood through fibrous lungs.
Deprived of blood the kidneys fail first. Dialysis will keep them going forward a while longer, but without lung transplantation the heart eventually stops. Often we sit down with families before these final things happen to let them know the path their loved ones are on.
We seek out there values and goals. We let them know what we can accomplish and what we can’t. It’s often choosing between the lesser of two evils, and often I am conflicted about putting people in such difficult positions.
The journey of dying in the ICU from #COVID19 takes on average about a 6 weeks. I have seen what that does to families.
Despite our resources and technology we can do little but support our patients and their families through the process waiting for them to heal.
And though most who read this thread know that vaccination can prevent almost all of this, it is why those of us in healthcare struggle knowing this is now preventable. It’s a thought that torments us through every day of those 6 weeks.
@threadreaderapp Please compile.
really wish we had TGFβ kinase inhibitors to trial, on that note has there been a clinical trial for nintedanib (or pirfenidone for that matter) in pts w/fibrosis secondary to #COVID19 ARDS?
Lika some auto immune disorder with no end to scar tissie formation? With burns we used pressure garments but with lungs so stiff .... ?
My sibling’s doctor said lungs looked like he had worked in coal mine all his life and there was so recovery for that oxygen rest of his life which turned out to be only 3 weeks after he was discharged
This is exactly how it played out for our friend. She almost made it off the ventilator, but then she crashed and and was gone within 48 hours. It was a brutal 6 weeks for everyone.
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