What We Have Learned About #COVID-19 : Part One - Mass General Advances in Motion
►https://advances.massgeneral.org/pulmonary/article.aspx?id=1269
Le pronostic vital des malades nécessitant une intubation avec ventilation assistée n’est pas aussi catastrophique que l’avait affirmé une étude antérieure (►https://seenthis.net/messages/842942)
Mechanical Ventilation: Still Saving Lives
There exists a widespread impression in the lay press that mechanical ventilation in the setting of COVID-19 leads inevitably to death (examples here, here and here.) A major contributor to this inaccurate impression was a report from Northwell Health in New York published late April in JAMA (Richardson et al. 2020). The Northwell report received substantial media attention for its claim of mortality of 88% among ventilated patients. This claim was later corrected to indicate that mortality figures were determined by reporting only on those patients who had reached a definitive outcome (death or discharge) during the relatively short follow-up period of the study (average of ~4 days) and excluding the 53.8% of patients who remained alive and ventilated at the time of publication. Depending on the fate of the excluded patients, true mortality in the Northwell cohort could have been as low as 25% or as high as 97%—too broad to meaningfully inform clinical decisions. Fortunately, since that time, case series with more accurate 28-day mortality have become available (see Table 1) and report uncorrected mortality ranging from 15% to 50%. This is broadly similar to outcomes from pre-COVID-19 ARDS (Bellani et al. 2016) and should provide yet more reassurance that severe COVID-19 behaves largely the same as ARDS in the pre-COVID-19 era.