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
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
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 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
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?
Finally we need to consider the morbidity of ventilation
- CIPM or CCAW
- Delirium
- prolonged rehab
- VAP
Etc
You can follow @DrSimonAshworth.
Tip: mention @twtextapp on a Twitter thread with the keyword “unroll” to get a link to it.

Latest Threads Unrolled: