Mortality for mechanically ventilated patients {NOW WITH IMPORTANT CAVEAT, read repl} - Printable Version
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Mortality for mechanically ventilated patients {NOW WITH IMPORTANT CAVEAT, read repl} - BostonCard - 04-23-2020
https://jamanetwork.com/journals/jama/fullarticle/2765184
Quote:Mortality for those who received mechanical ventilation was 88.1% (n = 282). Mortality rates for those who received mechanical ventilation in the 18-to-65 and older-than-65 age groups were 76.4% and 97.2%, respectively.
Yikes! I knew mortality was high for patients who made it onto the ventilator, but I thought high meant >50%, not 88% (and 97% for those over 65).
Also, there's a blurb about ACE/ARBs, which I will post in the appropriate thread.
BC
RE: Mortality for mechanically ventilated patients - 2006alum - 04-23-2020
Horrifying. I know one of the 11.9% in NYC who fortunately got back off the mechanical vent and lived to tell about it. Scary to think how rare his outcome was -- and it's almost certainly because he had no co-morbidities and is in his 40s.
RE: Mortality for mechanically ventilated patients - Genuine Realist - 04-23-2020
(04-23-2020, 01:15 PM)2006alum Wrote: Horrifying. I know one of the 11.9% in NYC who fortunately got back off the mechanical vent and lived to tell about it. Scary to think how rare his outcome was -- and it's almost certainly because he had no co-morbidities and is in his 40s.Then there is Boris Johnson, although he never went on a ventilator.
Do we have some selection bias here? The class of patients who go on ventilator are already moribund?
RE: Mortality for mechanically ventilated patients - BostonCard - 04-23-2020
(04-23-2020, 01:18 PM)Genuine Realist Wrote:(04-23-2020, 01:15 PM)2006alum Wrote: Horrifying. I know one of the 11.9% in NYC who fortunately got back off the mechanical vent and lived to tell about it. Scary to think how rare his outcome was -- and it's almost certainly because he had no co-morbidities and is in his 40s.Then there is Boris Johnson, although he never went on a ventilator.
Do we have some selection bias here? The class of patients who go on ventilator are already moribund?
Oh, absolutely. There is no question that compared to someone who never goes on a ventilator, the risk of death of someone who needs a mechanical ventilator is much higher. But my experience in critical care is that it is something like 5% for hospitalized patients not on a vent and 20% for hospitalized patients on a ventilator. That's why when I started to hear reports of "high mortality" for mechanically ventilated patients, I thought it would be 50%, not 80+%.
I was on a check-in call with several colleagues from my department this morning. One was our department head, who is a Spaniard. He listed the about a half-dozen of his family members who were affected by the virus, including a sister-in-law who perished. Fortunately everyone else, including his daughter and son-in-law had milder disease and survived.
One of my other colleagues on the call was a Chinese immigrant, but still has family in Wuhan. She was in tears describing the situation there. She talked about people dying in their apartments and officials coming in white hazmat suits to pick up and dispose of the body. Basically reiterated what we've heard reports of, which is that official statistics dramatically understate the number of deaths in the region.
BC
RE: Mortality for mechanically ventilated patients - dabigv13 - 04-23-2020
These numbers are worse than what were seeing in California. I suspect NY being overloaded was big factor in these high numbers, where you had nonintensivists in sometimes makeshift ICUs running ventilators for the first time in their careers.
RE: Mortality for mechanically ventilated patients - BostonCard - 04-23-2020
(04-23-2020, 01:37 PM)dabigv13 Wrote: These numbers are worse than what were seeing in California. I suspect NY being overloaded was big factor in these high numbers, where you had nonintensivists in sometimes makeshift ICUs running ventilators for the first time in their careers.
One other hint that this was true was that among patients over 65 who died, only 42% had received mechanical before dying. There are lots of reasons for that (sudden deaths on the floor, patients deciding to be DNI), but it could also reflect an overloaded ICU with ventilators being triaged and not offered to patients at high risk of death.
BC
RE: Mortality for mechanically ventilated patients - Genuine Realist - 04-23-2020
(04-23-2020, 01:40 PM)BostonCard Wrote:FWIW, my daughter tells me that the word around the ER's is that, if you've got a 19 patient coding, don't bother with Code Blue. He ain't comin' back.(04-23-2020, 01:37 PM)dabigv13 Wrote: These numbers are worse than what were seeing in California. I suspect NY being overloaded was big factor in these high numbers, where you had nonintensivists in sometimes makeshift ICUs running ventilators for the first time in their careers.
One other hint that this was true was that among patients over 65 who died, only 42% had received mechanical before dying. There are lots of reasons for that (sudden deaths on the floor, patients deciding to be DNI), but it could also reflect an overloaded ICU with ventilators being triaged and not offered to patients at high risk of death.
BC
RE: Mortality for mechanically ventilated patients - BostonCard - 04-26-2020
(04-23-2020, 01:10 PM)BostonCard Wrote: https://jamanetwork.com/journals/jama/fullarticle/2765184
Quote:Mortality for those who received mechanical ventilation was 88.1% (n = 282). Mortality rates for those who received mechanical ventilation in the 18-to-65 and older-than-65 age groups were 76.4% and 97.2%, respectively.
Yikes! I knew mortality was high for patients who made it onto the ventilator, but I thought high meant >50%, not 88% (and 97% for those over 65).
Also, there's a blurb about ACE/ARBs, which I will post in the appropriate thread.
BC
A very very important clarification to the study was published. The 88.1% mortality referred only to patients with adjudicated outcomes (dead or discharged), but the majority of patients in the study were still on the ventilator at the time when the article was written. Here's the full clarification:
https://jamanetwork.com/journals/jama/fullarticle/2765367?guestAccessKey=df335e22-9e3f-41bd-898d-05623185c2c1&utm_source=silverchair&utm_campaign=jama_network&utm_content=weekly_highlights&cmp=1&utm_medium=email
Quote:In the Abstract, Results paragraph, the sentence reporting mortality for patients receiving mechanical ventilation should read, “As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital.”
The bottom line is that it is way too early to try to calculate the mortality of those patients, which will completely depend on what has happened and will happen to those 831 patients that remain hospitalized. Unfortunately, the authors didn't further break those patients down. If many or most of those are hospitalized but have been taken off the ventilator, their prospects for recovery and discharge are pretty good. If many or most of them are still on the ventilator, their prospects are uncertain. They may be ok if they've stabilized and are being weaned from the ventilator, which can be a slow process in some patients. On the other hand, if they are not making progress, their prospects are poor, because sooner or later they will get a secondary infection or some other insult will push them over the edge.
BC
RE: Mortality for mechanically ventilated patients - teejers1 - 04-26-2020
(04-26-2020, 09:41 AM)BostonCard Wrote:(04-23-2020, 01:10 PM)BostonCard Wrote: https://jamanetwork.com/journals/jama/fullarticle/2765184
Quote:Mortality for those who received mechanical ventilation was 88.1% (n = 282). Mortality rates for those who received mechanical ventilation in the 18-to-65 and older-than-65 age groups were 76.4% and 97.2%, respectively.
Yikes! I knew mortality was high for patients who made it onto the ventilator, but I thought high meant >50%, not 88% (and 97% for those over 65).
Also, there's a blurb about ACE/ARBs, which I will post in the appropriate thread.
BC
A very very important clarification to the study was published. The 88.1% mortality referred only to patients with adjudicated outcomes (dead or discharged), but the majority of patients in the study were still on the ventilator at the time when the article was written. Here's the full clarification:
https://jamanetwork.com/journals/jama/fullarticle/2765367?guestAccessKey=df335e22-9e3f-41bd-898d-05623185c2c1&utm_source=silverchair&utm_campaign=jama_network&utm_content=weekly_highlights&cmp=1&utm_medium=email
Quote:In the Abstract, Results paragraph, the sentence reporting mortality for patients receiving mechanical ventilation should read, “As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital.”
The bottom line is that it is way too early to try to calculate the mortality of those patients, which will completely depend on what has happened and will happen to those 831 patients that remain hospitalized. Unfortunately, the authors didn't further break those patients down. If many or most of those are hospitalized but have been taken off the ventilator, their prospects for recovery and discharge are pretty good. If many or most of them are still on the ventilator, their prospects are uncertain. They may be ok if they've stabilized and are being weaned from the ventilator, which can be a slow process in some patients. On the other hand, if they are not making progress, their prospects are poor, because sooner or later they will get a secondary infection or some other insult will push them over the edge.
BC
Look forward to all the commentators - scientific and MSM - ripping this report a new one for their sloppy methodologies that painted a misleading (or at least potentially very misleading) picture about the mortality rate . . . actually, I'm not.
RE: Mortality for mechanically ventilated patients - BostonCard - 04-26-2020
(04-26-2020, 11:02 AM)teejers1 Wrote: Look forward to all the commentators - scientific and MSM - ripping this report a new one for their sloppy methodologies that painted a misleading (or at least potentially very misleading) picture about the mortality rate . . . actually, I'm not.
Question (legit, I don't know), did the MSM cover this paper that much? This was the only article I could find:
https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study
I'm sure there are others, but there is so much COVID-19 coverage that I don't know that this specific article got that much coverage, and we all know that clarifications rarely get as much coverage as the original.
As for commentators, I can't speak for others, but I thought my misunderstanding of the article was significant enough that I replied to the post with the clarification and edited the subject so it said "NOW WITH IMPORTANT CAVEAT, read reply". I will happily rip the article for sloppy methodology if it would make you feel better, but the methodology of only using adjudicated outcomes is pretty standard, and the mortality from ventilators was not the main point of the paper (it was a general description of the experience with the outbreak in New York). Yes, they should have made clear that they were only talking about the relatively small subset of patients with an adjudicated outcome, especially as these days so much literature is coming out that many of us don't have the time to read papers with as much detail as is necessary.
BC