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Study: Ventilators Not Good for COVID-19 Patients

An American study by C.A. Gao et al titled “Machine learning links unresolving secondary pneumonia to mortality in patients with severe pneumonia, including COVID-19” published on 27 April 2023 kinda admits and kinda doesn’t that the use of ventilators which led to ventilator-associated pneumonia (VAP) for COVID-19 patients killed some of them.


The paper is 66 pages long. The main text is about 20 pages, the remaining are references, tables and figures.


The observational study analyzed “the contribution of VAP to mortality in 585 patients with severe pneumonia and respiratory failure, including 190 patients with severe SARS-CoV-2 pneumonia”.


Note that of the 190 patients with COVID-19 included in the analysis, 87 (45.8%) died. Of the remaining 395 patients without COVID-19, 156 (39.5%) died.


Overall, mortality was not significantly different in patients who developed VAP compared to those who did not. … Among these patients, the rate of unfavorable outcomes (hospice or death) was 17.6% in patients with a cured episode and 76.5% in patients with unsuccessful treatment (intermediate or not cured episode), p < 0.001. We also observed a similar pattern among the subset of patients with COVID-19. Patients with COVID-19 experienced longer durations of VAP episodes. Unresolving VAP episodes (those with an indeterminate outcome or that were not cured) were of longer duration than cured episodes.

Figure 7: Patients with COVID-19 experience more VAP episodes compared to patients without COVID-19.
Figure 7: Patients with COVID-19 experience more VAP episodes compared to patients without COVID-19.
Figure 8: Unresolving VAP is associated with worse outcomes.
Figure 8: Unresolving VAP is associated with worse outcomes.

I am no doctor but it seems, as the study states, there is no significant difference in mortality between the categories. However, COVID-19 patients are clearly more likely to get VAP (single and multiple episodes) and, in any case, uncured episodes more likely lead to death. The median cumulative ICU days for COVID-19 patients is 24 days whereas other categories range from 8 to 11 days.


So, one has to wonder whether there was, as some claim right at the beginning, that there was some accidentally-on-purpose over-reliance on ventilators for COVID-19 patients…

Interestingly, 76 patients received Remdesivir, of which 72 were COVID-19 patients. I could not find information regarding their status.

 

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