ICU Dr. Cameron Kyle-Sidell claims COVID-19 is primarily Hypoxia - consider not Intubating

[Pete W.]

Dr. Cameron Kyle-Sidell is an ED physician in New York. He tweeted a response at the end of March that challenged intubating COVID patients.

The following is from the audio discussion.

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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 ...

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... 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".

Listen to this very interesting audio discussion: ThinkingCriticalCare.com: COVID Clinical Discussion w/Cameron Kyle-Sidell NYC ED/ICU doc in the trenches. #FOAMed

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Another very interesting discussion about atypical acute respiratory distress syndrome from Italian physicians treating COVID patients.

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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.

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A possible explanation for such severe hypoxemia occurring in compliant lungs is the loss of lung perfusion regulation and ...

Read in its entirety and view graphics in the PDF: American Journal of Respiratory and Critical Care Medicine: Covid-19 Does Not Lead to a "Typical" Acute Respiratory Distress Syndrome

[eerrmm]

3 hours ago, Pete W. said:

... 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".

Welp really hope a hyperbaric chamber isn't what they need because that would make the ventilator shortage look like absolutely nothing.

[GrumpyRN, NP]

"Reports from Italy indicate that approximately 50% of patients given CPAP have avoided the need for invasive mechanical ventilation, reducing the demand on intensive care staff and beds."

https://www.nihr.ac.uk/news/life-saving-breathing-aid-developed-to-keep-covid-19-patients-out-of-intensive-care/24542

"There is a growing evidence base that there is a significant role for the use of CPAP in COVID-19 positive patients, more so than was initially understood."

https://www.ficm.ac.uk/news-events-education/news/letter-regarding-use-continuous-positive-airway-pressure-cpap-covid-19

[aolmoz, MSN, NP]

He’s right. Watch the EMRAP updates on you tube. There’s a lot of great information being discussed. Recommendations are changing practically daily because we are learning more as the days go by.

What we are seeing is more of an altitude sickness. Intubation may or may not help, but for a lot of people it’s starting to look like intubation just prolongs the dying process. I’m not saying we aren’t intubating, but a lot of research is beginning to show intubation might not be the life sustaining tool we once thought it was.