The discussion about who should be ventilated and who is not, flares up in the Corona-crisis again and again. The concern continues to be great, that breathing spaces could be in the hospitals close, if the spread accelerates. Also this is the reason why professional societies have published recommendations for Doctors, which may be used in an emergency as a criterion and what is not. Experts advise to recognise patients at risk, before.
The Corona Virus, but the treatment can affect people in very different ways. “A use statement for all cases, there can be,” says Guido Michels. He is the chief physician of the clinic for Acute and emergency medicine at the St. Antonius-Hospital in Eschweiler. Each individual case needs to be assessed. What Michels says so, it is clear gradients in the views of serious illness.
If the Virus triggers a severe lung inflammation that leads, under certain circumstances, due to the inflammation too little oxygen into the blood. Patients are connected to ventilators. This poses risks. The tubing may additionally arise to the viral disease, a bacterial infection in the lungs. A second inflammation of the lungs, so to speak. The risk is higher in patients whose bodies are weakened by pre-existing conditions anyway.
Only one third of the mechanically ventilated Patient leaves the ICU alive
Also can burst with too much pressure in the context of the ventilation of the lung structure. Also, the high proportion of oxygen with which the patient can be ventilated, this could cause damage to the lung tissue. The muscles of the diaphragm, the main breathing muscle, it can break down. “All of the complications or adverse effects of mechanical ventilation are associated with increased mortality,” says Michels. With the start of artificial respiration had to be kept in mind about the weaning.
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The German medical journal reported, citing a British study, only every third Patient who has been ventilated in the United Kingdom in the ICU, could live to be discharged. Other studies also show that the ventilation devices are no longer a guarantee for Survival. Should be the mechanical ventilation, so the Ultima Ratio?
Respiration rate of Survival increased
“That would be a big mistake,” says Michael Pfeifer, President of the German society for pneumology and respiratory medicine (DGP). If to be late with the invasive therapy will start, means simply a higher mortality. A sensible and proper ventilation can increase the survival rate, said Torsten Bauer, Vice-President of the DGP. The clear from experience with past illnesses. For Covid not give this data. But they should be available in the coming months, it said.
The decision about whether the conclusion of the outweigh, finally, risks or Benefits, is not black-and-white, says Lukas Radbruch, President of the German society for palliative medicine. Recommendations of professional societies, should only serve as background information for the discussion in individual cases, and not “as a Check-list”. Finally, the doctor decide what treatment he is offering, and which are not.
Non-invasive ventilation damages lungs less
A treatment option, according to Frank Heimann, Chairman of the Federal Association of pulmonologists and sleep and respiratory physician, including non-invasive ventilation. “This will be discussed under the ventilation specialists. The risk of damage to the lung, this method low.“ This Form of respiration is, however, associated with higher personnel expenses, because the Patient is often awake. Some people feared also more droplet production and thus a greater risk of Infection. The DGP makes a recommendation, however, that the fear of contagion should not be a primary intubation reason. Rather, protective clothing in hospitals is sufficiently necessary.
“For Corona, the necessary data is the basis for reliable statements to be made, just emerging,” says Heimann. In the treatment, the experience of the resuscitation team, as well as the available resources played out a particularly large role.
Expert: risk, patients should make in advance thoughts
Radbruch advises people and high-risk patients to make in advance thinking about what you want in the acute Situation, and if you want to be ventilated. For example, using a patient or an emergency bow. The determines which treatments are to be carried out in case of emergency and which are not. Radbruch frequently observed resistance against this conflict in nursing homes: “Many people don’t want to think about death and Dying.”
“If you had a contingency plan in place, it would be a great help in the clinics,” says Michels. Of emergency physicians suggests that regional palliative care network homes, together with homes for the elderly and care of these emergency plans developed. For each of the residents could be resolved, as in the specific case of the procedure to be followed. People who do not want to be ventilated, for example, could then be palliative supplied.
“Needs to choke, in hospitals, nobody”
Corona-patients who have no prospect of a cure, suffered especially under shortness of breath, says Radbruch. “This is often a source of anxiety.” It would add confusion, agitation, and cough, some diarrhea. Some patients complain of muscle pain, “as in the case of a strong flu, where a, the whole body hurts”.
In the palliative care approach with a morphine against the complaints. The patients feel no shortness of breath anymore. Ventilator patients in the hospital would be kept with medications in an artificial coma and felt no shortness of breath. “You must suffocate in hospitals no one. And also in the nursing homes,“ says Michels.
Radbruch has consulted at individual nursing homes, such as with Corona diseased people died. Do not be smothered, have you reported him. Otherwise, that could be in people who would not receive medical treatment and, for example, home to die.
Survey: people want to die pain-free
According to a representative survey conducted by the Berlin Institute for population and development people wish to be free from all pain, well supplied, close to the Usual, socially involved, and to die is self-determined. The survey was carried out in the framework of the study “On a word”, the on 23. April, to be published.
This wishes also be familiar with Radbruch from his work. He directs the center for palliative medicine at the Malteser hospital in Bonn, as well as the clinic for palliative medicine at the University hospital in Bonn. There are people who are Dying are allowed to receive unlimited visits. It had also recommended the German Interdisciplinary Association for Intensive and emergency medicine for the Corona – patients on intensive care units, in compliance with the safeguards. “The most important is that it gives people the Chance to Express what you want for the emergency,” says Radbruch.
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