• Richard Cree

Bread & Butter

Saturday 18th April 2020

COVID Figures for 17th April

UK Hospital Deaths 847 / Total 14,576

James Cook Hospital – Total deaths – 134

James Cook cases in Critical Care – 20 / 10 ventilated

I’ve finished my second night shift and so can now enjoy a few days at home. Once again, things weren’t too busy with only a few new cases. One was what I would call a regular or ‘bread and butter’ patient and nothing to do with COVID-19 for a change.

The patient was a lady in her 50’s with undiagnosed smoking-related lung disease, or Chronic Obstructive Pulmonary Disease (COPD). She had developed severe narrowing of the airways like an asthma patient. This is known as bronchospasm and it had worsened to the point that she required intubation and ventilation. The deterioration has probably been triggered by an infection but it is the bronchospasm that has led to her respiratory failure. Even ventilated, her airways were so tight that the ventilator was struggling. With treatment things started to settle down although I suspect she will stay ventilated for over a week. Even so, her prognosis, should she avoid further complications, is good.

This is quite a contrast to our COVID patients. Prior to the pandemic, we would be worried about patients who we thought were going to be on the ventilator for a fortnight. It will come as no surprise that the longer you stay ventilated, the worse your prognosis. Those patients who are ventilated for longer than three weeks often don’t do very well, especially if they are elderly and have existing heart or lung problems.

We currently have a collection of very sick COVID patients who have been with us for a fortnight already. One of these died today. He was a middle-aged gentleman without any medical problems who we watched slowly deteriorate over the past two weeks. He started out on CPAP, was intubated and ventilated, developed worsening respiratory failure and eventually succumbed to multiple organ failure. Nothing we did seemed to stop the inexorable progression of the disease. His death has upset all of us.

We are starting to realise just how high the mortality is for the ventilated patients. Up until two days ago we had only managed to extubate (remove the breathing tube and take off the ventilator) one patient with full blown COVID pneumonitis.

This is perhaps not as bad as it sounds. Yes, we have had a number of deaths, but the patients are taking a long time to get better; many of them have not had enough time to recover to the point where they can breathe by themselves. In the last two days we have successfully extubated two further patients and there is hope for a third over the weekend.

Slow and steady wins the race.

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