1. Experts/media were wrong again. 2. Ventilators were adopted w/o a random control test but nobody complained because Trump didn’t praise the usage. https://twitter.com/CNN/status/1253210003231694850 …
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Replying to @rabois
Nobody had time to do a test. The doctors had to guess what to do based on what had worked for patients with similar symptoms in the past. And I doubt very much the measures they tried were affected by anything Trump said.
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early intubation practice was based on experience from SARS/MERS but also driven by lack of PPE (noninvasive aersolization). COVID unique compared to traditional severe hypoxic resp failure which are usually accompanied by septic shock (necessitating intubation)
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alternative to intubation in almost all other diseases is usually a rapid death. Disingenuous to suggest management was driven by politics. All physicians were excited by HCQ to work early on, same with remdesivir. We all want a magic pill but we can’t be driven by anecdotes.
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Believe me I have been arguing against early intubation since mid march (based on Italian testimony using CPAP helmets which we lack) but have been hit with resistance bc lack of PPE. In general critical care has been moving more and more towards Noninvasive methods, esp HFNC
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but COVID unique as in almost all other infectious causes of hypoxia, this resp failure is rapidly followed by septic shock and death. This “happy hypoxic” patient is somewhat rare and unique to COVID so we are slowly learning to dial back the trigger
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until 3 weeks ago the belief was holding off intubation was akin to withholding a parachute. In most other disease processes we see rapid shock->arrest within 1-2 hours. We still see it sometimes with COVID but it’s worth the trial for 1-2h.
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