We need to do an analysis of late v early intubation strategies with #COVID19
Imagine an Early ventilation trigger of RR30 and SPO2<94 on 15L O2
vs
Late = exhaustion, severe agitation, incipient respiratory arrest
Imagine an Early ventilation trigger of RR30 and SPO2<94 on 15L O2
vs
Late = exhaustion, severe agitation, incipient respiratory arrest
Let’s imagine Late avoids 30% of intubations - this group will have a high survival, assume 100%
Imagine 70% ventilated have est 40% survival
Total 30%+28% = 58% survival
V
Early 50% survival
Imagine 70% ventilated have est 40% survival
Total 30%+28% = 58% survival
V
Early 50% survival
But it also means 30% more people can be ventilated…
The consequence is survival is actually
Late 58% + 30% x 40% = 70% survival compared to
V
Early ventilation 50%
The consequence is survival is actually
Late 58% + 30% x 40% = 70% survival compared to
V
Early ventilation 50%
The point of this is that late ventilation doesn’t have to be very successful to still improve survival overall…
Ventilation is not a panacea, and early ventilation in any resource limited scenario may not be a worse strategy…
#covid19
Ventilation is not a panacea, and early ventilation in any resource limited scenario may not be a worse strategy…
#covid19
The other question is whether deaths due to sudden cardiac arrest are genuinely avoidable, are they due to PE, or microembolism, cardiomyopathy, or a cytokines storm that presages poor outcome?
Or maybe it was just poor monitoring in challenged circumstances?
Or maybe it was just poor monitoring in challenged circumstances?
Finally we need to consider the morbidity of ventilation
- CIPM or CCAW
- Delirium
- prolonged rehab
- VAP
Etc
- CIPM or CCAW
- Delirium
- prolonged rehab
- VAP
Etc