Study Reveals Most Critically Ill Patients with COVID-19 Survive with Standard Treatment

Massachusetts General Hospital ^ | 05/07/2020 | Brian Burns

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Clinicians from two hospitals in Boston report that the majority of even the sickest patients with COVID-19—those who require ventilators in intensive care units—get better when they receive existing guideline-supported treatment for respiratory failure. The clinicians, who are from Massachusetts General Hospital and Beth Israel Deaconess Medical Center, published their findings in the American Journal of Respiratory and Critical Care Medicine.

During the COVID-19 pandemic, hospitals around the world have shared anecdotal experiences to help inform the care of affected patients, but such anecdotes do not always reveal the best treatment strategies, and they can even lead to harm. To provide more reliable information, a team led by C. Corey Hardin, MD, PhD, an Assistant Professor of Medicine at Mass General and Harvard Medical School, carefully examined the records of 66 critically ill patients with COVID-19 who experienced respiratory failure and were put on ventilators, making note of their responses to the care they received.

The investigators found that the most severe cases of COVID-19 result in a syndrome called Acute Respiratory Distress Syndrome (ARDS), a life-threatening lung condition that can be caused by a wide range of pathogens. “The good news is we have been studying ARDS for over 50 years and we have a number of effective evidenced-based therapies with which to treat it,” said Dr. Hardin. “We applied these treatments—such as prone ventilation where patients are turned onto their stomachs—to patients in our study and they responded to them as we would expect patients with ARDS to respond.”

Importantly, the death rate among critically ill patients with COVID-19 treated this way—16.7%—was not nearly as high as has been reported by other hospitals. Also, over a median follow-up of 34 days, 75.8% of patients who were on ventilators were discharged from the intensive care unit. “Based on this, we recommend that clinicians provide evidence-based ARDS treatments to patients with respiratory failure due to COVID-19 and await standardized clinical trials before contemplating novel therapies,” said co–lead author Jehan Alladina, MD, an Instructor in Medicine at Mass General.

Paper cited: Ziehr DR, Alladina J, Petri CR, et al. Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study [published online ahead of print, 2020 Apr 29]. Am J Respir Crit Care Med. 2020;10.1164/rccm.202004-1163LE. doi:10.1164/rccm.202004-1163LE

About Massachusetts General Hospital

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Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2019, Mass General was named #2 in the U.S. News & World Report list of "America’s Best Hospitals."

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I wouldn't get hung up on the hydroxychloroquine in this study. They are talking about ARDS in COVID and whether it represents a different entity than ARDS that happens with other respiratory illnesses. Their chart review is saying no that if you end up with a patient with ARDS regardless of cause the standard protocol for treating ARDS (low tidal volumes, prone positioning etc) will still give you the best outcome.

I get that we would all like to see some good numbers on people treated early with HCQ,Zpak and zinc. But until someone can duplicate Dr. Z's numbers I think we are stuck. Certainly the recent observational study out of Columbia Presbyterian seems to indicate that starting HCQ at the time of hospitalization doesn't really do much.

We won't have numbers on HCQ for prophylactic use until next year.

There was a Critical Care Doc in Las Vegas that had success with prone positioning before they get to intubation. As patients who don't improve and are borderline on whether they should intubate they are able to turn them around with prone positioning. This saves them from being intubated.

The unfortunate thing is we are watching medical research in real time. Studies usually take a year or more. Frontline Doctors are too busy and you have to rely on major centers to compile data since they have residents and fellows that can assist with data collection. It's hard to be patient when everyone that's not working is getting to the end of their savings.