https://thinkingcriticalcare.com/202...enches-foamed/
^^listen to podcast
Dr. Cameron Kyle-Sidell is an ED-ICU Doc at Maimonides in New York and recently opened a full COVID-19 ICU unit
"Everyone you talk to there is something about it no one can understand.
It's nothing like we've ever seen. For anybody that has intubated one of these patients I'm sure they've seen that they desaturate very quick and it doesn't seem to have any effect on their heart rate. I've seen desaturations in the 10s, 20s and to be honest a desaturation of zero for several seconds and without any effect on the heart rate. All these things are happening which don't make sense and to be perfectly honest I have no come to the conclusion that we are now treating the wrong disease....
What's amazing about this condition is it's uniformity.
COVID does not cause a condition leading to respiratory fatigue, there is no fatigue. This is a purely hypoxemic condition and the same goes for palliative patients. They do not struggle at the end of life in so far as having respiratory fatigue. It's purely hypoxemic and they go through symptoms of anxiety, Tachypnea and eventually bradycardia and it's nearly uniform.
It's been five days so I can speak as if I've been treating this for years but it seems to be that way.
I was an ER doctor for a long time and I have never seen this condition and I have really come to the conclusion that it is most closely clinically related to a condition I have never seen which is pulmonary decompression sickness or "the bends". It seems from reading this happens to be a rare disease within a rare disease....
We have taken patients pretty far on high flow (oxygen therapy) and then for some reason it stops and they start getting better....
and if you look at what Gattinoni and the Italians put out on March 20th that is what they are saying __________________________________________________ ____________
https://www.atsjournals.org/doi/10.1....202003-0817LE
Am J Respir Crit Care Med. 2020 Mar 30. doi: 10.1164/rccm.202003-0817LE. [Epub ahead of print]
Covid-19 Does Not Lead to a "Typical" Acute Respiratory Distress Syndrome. (ARDS)
Gattinoni L1, Coppola S2, Cressoni M3, Busana M4, Chiumello D2.
https://foro.coronavirusmakers.org/u...3ajdadsoq5.pdf
D. Chiumello1 , M. Cressoni2 , L. Gattinoni3 , 1San Paolo Hospital, University of Milan, Via Antonio Di Rudinì 8, 20142, Milano, Italy, +393291247364 2San Gerardo Hospital, University of Milan-Bicocca, Via Gian Battista Pergolesi 33, 20900, Monza, Italy, +393395026685 3Medical University of Göttingen, Robert-Koch Straße 40, 37075 Göttingen, Germany, +393356288731
Dear Editor,
In northern Italy an overwhelming number of patients with Covid-19 pneumonia and acute respiratory failure have been admitted to our Intensive Care Units. Attention is primarily focused on increasing the number of beds, ventilators and intensivists brought to bear on the problem, while the clinical approach to these patients is the one typically applied to severe ARDS, namely high Positive End Expiratory Pressure (PEEP) and prone positioning. However, while fulfilling the ‘Berlin criteria for ARDS’1 the patients with Covid-19 pneumonia have a specific disease, with a similar phenotype. The most peculiar characteristics we are observing (confirmed by colleagues in other hospitals), is the dissociation between their relatively well preserved lung mechanics and the severity of hypoxemia. As shown in our first 12 patients (Figure 1), the respiratory system compliance of 52.1 ± 15.4 ml/cmH2O is associated with shunt fraction of 0.51 ± 0.10. Such a wide discrepancy is virtually never seen in most forms of ARDS. Relatively high compliance indicates well preserved lung gas volume in this patient cohort, in sharp contrast to expectations for severe ARDS.
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Intubation
Intubation is the process of inserting a tube, called an endotracheal tube (ET), through the mouth and then into the airway. This is done so that a patient can be placed on a ventilator to assist with breathing during anesthesia, sedation, or severe illness.
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