Didn't realize 70-80% of patients on vents will die

[WombOfOnesOwn]

Just that, really.

I am friends with healthcare providers, several in emergency departments and intensive care/treatment units, from several different countries and US states. In talking to them about coronavirus, the thing that shocked me most, especially given the huge push for ventilators, is that most ventilated patients will still die.

Somehow I guess I figured it was 50/50 or better, especially with how everyone's acting about the shortages of ventilators. It's also awful because I think a lot of the people about to be ventilated don't realize how bad their odds are.

I've seen similar numbers from several different people, so I don't think it's just one bad hospital where a friend is working reporting bad stats.

I have been trying to get information about how much of this is age related, but with very little luck. My parents (in their 60s) and I (in my 30s) would like to know what those chances are so that we could be realistic about decisionmaking in the circumstance that we were among the unlucky few to end up in this situation.

Does anyone have some light they can shed? Studies or recent research? Or anything contradicting what I've heard so far, that indicates better success getting patients off-ventilator and recovered? It's a lot of trauma to put the human body through when the odds start growing slimmer.

I think the public have over optimistic ideas about how successful ventilation will be. If the lungs are unable to function a ventilator won't change that. If the lungs can't exchange gases then as far as I know ECMO is the only chance and that provision is vanishingly small in the UK. Even that won't guarantee survival.

Indeed, people will also tend to fight against ventilators, the two people I've known who required ventilation just wouldn't accept the machine taking over. One of whom was a previously very fit and healthy young person. Ventilators are not in themselves a guaranteed cure.

@Melroses As quickly and as pain free as possible is all we can hope for. My friends mum is dying at the moment. He was saying how she won't eat and worrying about it. I gently explained that her being frail and not eating will help her body to pass away more quickly, and help the pain relief have a stronger affect too.

Its Bloody awful, however they go

I gently explained that her being frail and not eating will help her body to pass away more quickly, and help the pain relief have a stronger affect too.

I didn't know this, that gives me some comfort about older family members who passed away and this happened in the weeks before.

@SonicVersusGynaephobia So sorry about your family members

@planetmuff please could you tell me what course of action is likely to be taken if one of your residents gets the virus? Having read an (horrific) diary of a London doctor’s week on Twitter earlier, she described a conversation regarding a care home resident with symptoms being left where they are rather than brought in. But surely that is putting other residents at risk? And what palliative care would be provided in the home? My Dad is 78, frail and in a home, with a severe chronic lung condition .

@SirChing :
True.
Also, dehydration makes people very, very sleepy.
Being sleepy and sleeping a lot can be very helpful when you're dying....though, it can, and does, distress families.

Decisions to ventilate are complicated. It's always better not to ventilate if you can, because all the time the patient is sedated, they are losing muscle mass and there can be a huge psychological impact. Add to that, you are bypassing all the usual processes that take place during respiration and putting a tube directly into the trachea. That brings with it a risk of ventilator acquired pneumonia (VAP). Patients can become ventilator dependent.

Having said that, doctors will sometimes preemptively ventilate. They might notice that a patient is getting exhausted and tell them that, in their opinion, they will have to be ventilated in 6-7 hours, but that would be an emergency situation. It would be better to ventilate in a planned and controlled way, so they may decide to ventilate before the patient must be ventilated to survive.

Very sick patients die, every day, with or without this crisis. Sometimes the very sickest patient pulls through and it's a complete surprise to everyone. Sadly, sometimes seemingly the least sick patient dies anyway.

Statistics are just numbers. Every patient is treated as an individual and decisions are made in their best interest, minute by minute, if necessary.

sleepwhendie palliative care would involve keeping the person as comfortable as possible, very much similar to if they were in a hospital. The GP can prescribe medications to alleviate symptoms which can be given by nursing staff in a nursing home or by nursing staff in community care teams if its a residential home.

I actually do not want to be ventilated, if I get that bad. I'd actually rather not be in hospital at all if they are going to insist on it at some point. I am not strong enough to survive ventilation, I am already weak muscle-wise and the further loss of what muscle I have left would be pretty devastating. I would far rather have palliative care only, if it came to it.

Not a pleasant subject, is it! I do feel strongly it's something we must think about and maybe have 'the conversation' with loved ones as to what we would want. I do far better if I am informed and know what to expect rather than being in the dark and then having these things thrust upon me. I would also feel it's better in my case for a younger person to get that sort of intensive care, rather than me. If it comes down to it, then I can accept this is it.

Goodness, now I need to cheer myself up!

It's good to start those conversations. My mum has started talking about it, which I am pleased about as she has always been so frightened of death. Now she would prefer to die at home than in one of the new centres they are building. Can't say I blame her.

German low age death rate makes sense. As does the wide testing. Family there had home test based on mild symptoms (but qualified via questions) and were negative. That’s not happening here, or anywhere near it. People do need to stop repeating the recording thing which is incorrect.

It will change as it reaches the older age groups.

The information on here re ventilators is a tough read but I’d rather know it.

SirChing interesting points re legality.

On R4 the other day a Dr clearly stated to have conversations now with your elderly relatives about where they would like to die. Given that chances are so low of survival, people succumb quickly and they may wish to be home.

It really struck me as a new piece of narrative in the whole thing. I felt quite surprised to hear it.

New CPAP created, will be tested then F1 can produce 1000 a day if go ahead. Can help as another option.

New CPAP created, will be tested then F1 can produce 1000 a day if go ahead. Can help as another option

Yes! Have just read about this on the BBC news site.

www.bbc.co.uk/news/health-52087002

On R4 the other day a Dr clearly stated to have conversations now with your elderly relatives about where they would like to die

I’ve heard the same, a British doctor on Channel 4 and an Italian Dr on Sky, I think. Part of the discussion was about dying in hospital with only staff present or at home with family.

There is a bit in the Extremely Vulnerable Persons info that states that those with less than six months to love can choose not to follow the guidance (presumably because sharing a bed with a partner and walking in the park might legitimately be described as more important than beIng shielded by 12 weeks indoors, not being touched by anyone).

I think we will see more of this pragmatic approach being discussed in the coming days.

Perhaps this is the sort of cultural shift that will leave a lasting legacy on our country? We aren’t very good at talking about death.

@CrunchyCarrot it would be a good idea, in current times, if you have that conversation with your loved ones, or even write it down. When deciding treatment plans, if the patient can't communicate their wishes clearly, then their nearest relatives are talked to and if there is a clear wish not to be ventilated, that would be listened to.

@MarshaBradyo Dying at home is fine, but it's good to let the GP know who can provide appropriaye meds. Which is very different from not telling anyone until afterwards.

It's bloody awful that these conversations have to be had

I think there are many questions to be answered about those potentially deciding to die at home.

There's a big difference between dying at home, with the support of hospice at home or Macmillan or district nurses and being abandoned to just be left unable to breathe and without any support or comfort care.

Given that chances are so low of survival, people succumb quickly and they may wish to be home.

Even the majority of over 80 year olds will survive Covid (80%+ survive)

Aesop it’s worth listening to the R4 piece to get a better picture of what was said.

A 102 year old has recovered in Italy. They nicknamed her ‘Highlander - the Immortal’

edition.cnn.com/world/live-news/coronavirus-outbreak-03-27-20-intl-hnk/h_5918ca3847643824cacb89755b89abd2

It wasn’t a transcription as impossible. The crux of it was have a conversation.

you really need to be in the best shape possible (as u can be on a vent..) to have any sort of chance

Which is why you can still go out to exercise

I live in Germany

Main reasons I expect lowish death rate in Germany, even now it has spread to older people:

(mostly comes down to decades of investment - and higher taxes to pay for it all)

500,000 tests per week
Possible due to available public health staff,
large network of labs across the country
and major pharmaceuticals base to manufacture reagents etc needed for kits
(NHS still can't do 10,000 per day - resouces)

A top notch health service that normally has a lot of spare capacity:
more doctors, equipment, ordinary hospital beds as well as critical care beds than any other country in Europe

Every CV patient can be given the full care they need, at every stage of the illness, not just when it becomes an emergency.
More GPs too, so patients will have had a history of health checks, being treated promptly, meds up to date

Monitoring:
people who are tested positive would usually get a daily phone call,
which is partly to check they are staying home - big fines if they go out -
but also to get a daily report of any changes in symptoms
This means that any deterioration is treated promptly, which can avoid some people becoming very ill or dying.

Deaths on ventilators here are a little below 50%

So the OP is too pessimistic imo