Hospitals Retreat From Early Covid-19 Treatment

 "Advances also include new drugs, most notably steroids, for severely ill patients.

Last spring, doctors put patients on ventilators partly to limit contagion at a time when it was less clear how the virus spread, when protective masks and gowns were in short supply. Doctors could have employed other kinds of breathing support devices that don't require risky sedation, but early reports suggested patients using them could spray dangerous amounts of virus into the air, said Theodore Iwashyna, a critical-care physician at University of Michigan and Department of Veterans Affairs hospitals in Ann Arbor, Mich.

At the time, he said, doctors and nurses feared the virus would spread through hospitals. "We were intubating sick patients very early. Not for the patients' benefit, but in order to control the epidemic and to save other patients," Dr. Iwashyna said. "That felt awful."

Ventilators can injure lungs by causing too much strain as the machines force in air. They deliver air and oxygen through a throat tube, which the body typically fights. "We've got gag reflexes that are pretty hard to go away, precisely to avoid things going into our lungs," Dr. Iwashyna said.

As a safety precaution, doctors and hospitals limited the access of health-care workers to coronavirus patients on ventilators, giving them fewer opportunities to check on them. That meant patients required more powerful sedatives to keep them from pulling out throat tubes. Sedation increases risk for delirium, research suggests, and delirium increases the likelihood of long-term confusion and death.

Subsequent research found the alternative devices to ventilators, such as delivering oxygen through nasal tubes, weren't as risky to caretakers as believed. Doctors also gained experience with Covid-19 patients, learning to spot signs of who might suddenly turn seriously ill, some said." [1]

1. Hospitals Retreat From Early Covid-19 Treatment --- Changing practices appear to be improving outcomes for sickest
Evans, Melanie. Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]21 Dec 2020: A.1.