Two globally-renowned research and teaching hospitals in Boston have come up with solid evidence that standard treatment for Covid-19 patients suffering Acute Respiratory Distress Syndrome (ARDS), results in the best survival rates. Comparing the tried and tested therapy for ARDS with newer or novel approaches to Coronavirus-infected patients in ICU’s showed a lower death rate for the former. In other words, stick to what you know works, while awaiting the results of standardised clinical trials, before working in novel new ways. It’s been the bedrock of healthcare ever since the proper advent of evidence-based medicine just over 42 years ago. Yet the debate over using untested therapies rages on after the SARS virus, then Ebola (until vaccines were developed), simply because clinicians were desperate and wanted to save lives as populations wilted around them. Current untested Covid-19 remedies have the backing of some influential leaders (however discredited US President Donald Trump’s controversial views might be, an alarming number of people listen to him), but the evidence so far is that they do more harm than good. Again, it’s back to medical basics, in this case the central tenet of patient care; First Do No Harm. Story courtesy of Medical Brief. – Chris Bateman
Most critically ill Covid-19 patients survive with standard treatment
From Medical Brief*
Clinicians from two US hospitals report that the majority of even the sickest patients with Covid-19 – those who require ventilators in intensive care units – get better when they receive existing guideline-supported treatment for respiratory failure.
Clinicians from Massachusetts General Hospital (MGH) and Beth Israel Deaconess Medical Centre, have found that the majority of even the sickest patients with Covid-19 get better when they receive existing guideline-supported treatment for respiratory failure. During the Covid-19 pandemic, hospitals around the world have shared anecdotal experiences to help inform the care of affected patients, but such anecdotes do not always reveal the best treatment strategies, and they can even lead to harm. To provide more reliable information, a team led by Dr C Corey Hardin, an assistant professor of medicine at MGH and Harvard Medical School, carefully examined the records of 66 critically ill patients with Covid-19 who experienced respiratory failure and were put on ventilators, making note of their responses to the care they received.
The investigators found that the most severe cases of Covid-19 result in a syndrome called Acute Respiratory Distress Syndrome (ARDS), a life-threatening lung condition that can be caused by a wide range of pathogens.
“The good news is we have been studying ARDS for over 50 years and we have a number of effective evidenced-based therapies with which to treat it,” said Hardin. “We applied these treatments – such as prone ventilation where patients are turned onto their stomachs – to patients in our study and they responded to them as we would expect patients with ARDS to respond.”
Importantly, the death rate among critically ill patients with Covid-19 treated this way –16.7% – was not nearly as high as has been reported by other hospitals. Also, over a median follow-up of 34 days, 75.8% of patients who were on ventilators were discharged from the intensive care unit.
“Based on this, we recommend that clinicians provide evidence-based ARDS treatments to patients with respiratory failure due to Covid-19 and await standardised clinical trials before contemplating novel therapies,” said co-lead author Dr Jehan Alladina, an instructor in medicine at Mass General.
- David R Ziehr, Jehan Alladina, Camille R Petri, Jason H Maley, Ari Moskowitz, Benjamin D Medoff, Kathryn A Hibbert, B Taylor Thompson, C Corey Hardin
Massachusetts General Hospital material
American Journal of Respiratory and Critical Care Medicine correspondence