In conditions when no drugs against new coronavirus-type SARS-CoV-2, the only “life-saving straw” that is able to save lives of severe patients with atypical pneumonia COVID-19, are considered to be devices of artificial ventilation of lungs (IVL).
the Press service of the Mayor and Government of Moscow. Maxim Mishin Noted that ventilation may not be as effective against the coronavirus as hoped doctors
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In conditions when no drugs against new coronavirus-type SARS-CoV-2, the only “life-saving straw” that is able to save lives of severe patients with atypical pneumonia COVID-19, are considered to be devices of artificial ventilation of lungs (IVL).
the Governments of almost all countries facing the pandemic coronavirus involved in the global race for medical ventilators. In Russia from 95 thousand beds, which will prepare by the end of April for patients COVID+, only 30% will be equipped with a ventilator. Devices are not enough. All medical institutions of the Russian Federation a total of about 43 thousand pieces. In late March the Russian government has allocated 7.5 billion rubles for the purchase of 5.7 thousand IVL.
But on the eve of the Minister of health of the Russian Federation Mikhail Murashko said that of all the 17-odd thousand patients (the data for April 13), with a specific viral community-acquired pneumonia to the ventilator in the medical institutions of the country connected more than 250 people. And an increasing number of severe patients there is a positive trend, “they are removed from artificial ventilation of lungs.”
In the background of these figures are of interest from several international studies conducted that have questioned the benefits of technology artificial lung ventilation in the treatment of infections COVID-19. It is noted that the ventilator may not be as effective in dealing with the coronavirus, as hoped, the doctors. Intubated patients often die, so many doctors suggest using alternative therapies.
For example, in a study of the British National Centre for audit and research intensive care (ICNARC) indicate that of the 1053 is connected to the ventilator patients with COVID only 355 survived (33.7 per cent). A study conducted in Wuhan, China, and published in the medical journal The Lancet, draws an even darker picture: only three survived of the 22 intubated patients (13,6%).
a Similar observation from Seattle, published the oldest and most influential American medical journal The New England Journal of Medicine, shows that of the 18 intubated patients, only nine survived, but at the end of the observations, three of them still could not breathe on his own.
according to the German magazine Focus, such studies provet that the mortality rate among patients COVID+ connected to the ventilator and significantly higher mortality intubated patients with other diseases. The magazine cites the research of several doctors in new York, which shows that among those patients with coronavirus infection, who it was connected to a ventilator, 80% eventually died.
In this regard, the American doctors offer alternatives to this treatment. One of them is shifting infected with the coronavirus to the abdomen, which eases the burden on the lungs. In addition, it is recommended that the supply to patients of oxygen through the oxygen mask and nasal cannula (tube in the nose), and feed patients nitric oxide, which facilitates blood flow and helps to carry oxygen to the least damaged part of the lungs.
Note that these methods are used in Russian hospitals since the early days of the epidemic of the coronavirus. Some patients, indeed, it is possible to compensate for conventional oxygen therapy, including lying on his stomach. But with this approach, the basic condition of safety is frequent monitoring of gas exchange as the lungs cease to perform this function. With regard to nitric oxide, then 15 years ago a study was conducted which suggested that this substance can suppress the reproduction in the lungs, “close relative” of the novel coronavirus that causes severe acute respiratory syndrome (SARS).
Clinical trials with nitric oxide on coronavirus patients have already begun, scientists from USA, Italy and other countries, believing that the use of this gas not only greatly facilitates the treatment of seriously ill patients, but also can be used as prophylaxis to prevent infection of medical staff. Nitric oxide is commonly used to treat patients with lack of oxygen, to improve the flow velocity, reduce blood pressure, in the treatment of chronic obstructive lung diseases.
many infected COVID-19 develops acute respiratoryTorno distress syndrome (ARDS). SARS-CoV-2 in viral RNA encoded proteins attacking red blood cells and binds to hemoglobin molecules, which in turn “collect” oxygen in the lungs, and then ensure its delivery to the tissues of the body. These encoded proteins amplify the inflammatory processes in the lungs – occurs hypoxemia, ARDS. But when a patient connected to a ventilator, it is often followed by septic shock and deny the other organs, there is multiple organ failure. Nitric oxide can be used as “rescue therapy” for severe cases of the disease COVID-19, said the chief anesthesiologist at the Massachusetts General hospital and Professor at Harvard medical school Warren Zapol.
“We believe that if you improve the patient’s condition without inkubirovanija and connection to a ventilator, then there will be more chances of recovery,” said the ambulance doctor new York Joseph Hubbuch.
At the same time, skeptics point out that the theory of high mortality from COVID-patients on mechanical ventilation have not been studied properly. Intubation is always associated with risk of complications, the pneumonia. Germs can enter the body of the patient through the tube and cause further inflammation. Therefore, the pneumonia often develops as a secondary disease on the background of the use of a ventilator.
So, the question remains open whether the artificial ventilation of the lungs in some way contributes to the death of patients with COVID-19, or as heavy patients so aggravated by concomitant diseases that they lose their chance to survive even being connected to a ventilator. While the small number of observed cases does not give an unambiguous answer. And those who could observe heavy patients, collect information and analyze it, not yet, the doctors are busy with other business – hourly attempts to save lives.
