Doctors in ERs and ICUs are trying new approaches and using social media and email chains to help each other learn on the fly.
Nurses put on protective equipment at a new Covid-19 Hospital on March 29, 2020 in Verduno, northwestern Italy.Dr. Robert Cerfolio says his"aha" moment came at the bedside of a COVID-19 patient, who seemed literally to be suffocating to death on his own mucus.
Cerfolio overrode the guidance. The patient lived. And Cerfolio and his colleagues at NYU Langone developed a new protocol for protective equipment and other precautions for doctors willing to do the procedure. They have since performed bronchoscopies on hundreds of COVID-19 patients. Through his research Yadegar realized that what he was seeing was a"cytokine storm," an overactive inflammatory reaction often seen in the sickest COVID-19 patients, a reaction so virulent it can kill. Soon he identified several blood markers, like the levels of ferritin, a protein that contains iron, that seemed to predict which patients were most likely to develop the overactive immune response.
Through these kinds of discussions and experimentation, unexpected observations are emerging that could transform care in the months ahead. One of the more significant is the debate about when best to place patients on ventilators. The finding is significant. Not just because it saves ventilators for sicker patients but because in order to go on a ventilator, the patient must be put in a medically induced coma, and there is anecdotal evidence that the pressure exerted by mechanical breathing machines can be injurious to the lungs of COVID-19 patients, Weingart says.
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