My first disclaimer is that pulmonology and critical care medicine are not my specialty. I am formally trained in Pediatrics with a subspecialty in Sports Medicine (all ages). That said, this article from about 5 months ago caught my interest because it takes a comprehensive look at the pathophysiology of COVID-19 pneumonia with new eyes and fresh perspective. It exposes many of our misconceptions about what we once thought was happening in the lungs of the afflicted, to where we are now in our understanding. Granted, this is complex information and is best suited for medical professionals (physicians, ICU nurses, perfusionists, RT's, etc) but can be understood if you have had basic college level biology and physiology. What should you take from this paper. 1) understanding about this disease is evolving as it is different from diseases we that seem similar on the face but are really quite different. 2) treatment and what will work and what will harm vary greatly depending on the patients station through the course of the illness. 3) learning about how to best treat this disease is an ongoing process and we currently do not have all the answers. What is the relevance to SAV? Answer: There is no way on earth that any untrained family member, like we typically see in these SAV cases, could possibly even be able to scratch the surface of the complexity of the management of severe COVID-19 disease. The best physicians in the business are learning every week what works and what doesn't and the jury is still out, and will be for sometime. While I have sent patients to the hospital and to the ICU with this disease I do not manage them nor do I try and second guess my intensivist colleagues who do. I truly know that their hearts and minds are in the right place and that they are doing everything within their power to heal and save my patients and return them to their families. However, as we can see from this paper, not everybody is going to respond to the treatments we have, nor can we currently save everybody. The keys to the lock box on this have not yet been made. Family members and the general public need to see just how complex caring for this disease is, what goes on behind the scenes at developing and modifying the best treatments to date are complex and extremely difficult. Nobody I practice with in our health care system is willingly out to harm patients. We want them all to go home to their families even if they were not vaccinated, even if they are victims of misinformation and even if we do not agree with them socially and politically. We leave our bias at the door, do the best jobs we can, often with little rest or sleep and sincerely hope for better days to come. I hope we do have some pulmonologists and intensivists on this forum who can critically comment on the materiel in this paper. I would be most interested in hearing your thoughts and experiences...
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Thank you for posting this. It is abundantly clear, when reading the Facebook posts made by the relatives of Covid patients who appear on this site (and others like it), that they simply do not understand that this disease is new, and that treatments are evolving and changing, and that if it was merely a case of giving patients I/V vitamins and a little Ivermectin, there would not be any requirement for ICU care, intubation, tracheostomy, etc. etc.
The people featured on this site just don't get it. It baffles me that members of this cult genuinely seem to believe that there is an ongoing conspiracy whereby hospitals, doctors, nurse, & other HCPs are deliberately harming patients and trying to murder them.
How anyone can really believe this nonsense is a mystery to me.
Not an intensivist nor pulmonologist, just anesthesia—but as such often consulted for ICU care and procedures (intubations, vascular access line placement, vent settings, etc) in a rural small hospital setting before retirement.
A challenging and complicated disease process. I have found these patients do not respond in accustomed fashion to our usual medications under anesthesia. Our usual pressors (to support low BP) phenylephrine and ephedrine are less effective which makes sense as this is a virus that affects the vasculature. I have had to incorporate more vasopressin and even pressor drips (dobutamine, dopamine, levophed) where we rarely need these meds on non-covid patients. Interestingly, can surmise that a patient has had a prior unknown infection when this happens during a routine anesthetic on a presumably covid naive patient. These patients are not like any we have experienced before. Our usual “tools of the trade” have had to be modified and changed repeatedly. What worked for one may not work for another. What is working in New York or Arizona may be ineffective or less effective in Midwest. Too many variables to determine if that is a truly regional difference or just an inter-patient difference.
Totally concur that we see only a human in need of our care and expertise when we arrive at bedside—all other issues disappear and our focus is to ultimately send these patients home to their families. Unfortunately we often have to transition that goal to the more patient centered keeping them comfortable when treatment options have been exhausted and proved ineffective.
Once out and no longer at bedside the knowledge that all this can now be avoided through vaccination is wearing and infuriating. My utmost respect to those still trying their best to keep these patients alive through the ever changing treatments and approaches even as patient families become more strident and full of vitriol towards the providers of care.