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Anchor lead: What is the role of ventilators in managing severe COVID-19? Elizabeth Tracey reports

When it comes of managing people with severe COVID-19 disease, some clinicians are questioning the need for ventilators, citing low survival rates and lengthy hospitalization. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, offers his opinion.

Garibaldi: At a fundamental level this disease causes ARDS, or acute respiratory distress syndrome. That’s a syndrome that’s been recognized for over fifty years. The only thing that’s really been shown to improve outcome is the way that you ventilate someone, using a low tidal volume ventilation strategy, and I think that we need to make sure that as we’re trying to gather more data about this disease, until we have data that says that that’s not the right way to ventilate these patients, I think we need to go with what twenty years, thirty years of data now has shown what has been effective with ARDS patients, that we know can save lives.  :30

Garibaldi says non-invasive strategies to provide more oxygen to people with severe COVID-19 are well worth trying, but that if ventilators are needed they should be employed. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: People with COVID-19 infection may have low oxygen levels in their blood yet not seem to struggling to breath, Elizabeth Tracey reports

COVID-19 infection sometimes results in low oxygen levels in someone’s blood yet they don’t say they are short of breath and may not seek medical attention until levels are very low. Brian Garibaldi, a critical care medicine expert at Johns Hopkins, describes what he’s seen clinically.

Garibaldi: There’s this term that’s risen up called the happy hypoxic. Or the patient who is requiring lots of oxygen but is not working hard to breath. It’s important to go back to physiology to think about what this could mean. There’s a natural spectrum where some people are much more short of breath at lower oxygen levels than others but I also worry that people are missing subtle findings of increased work of breathing. We know that respiratory rate is notoriously measured incorrectly. It’s very easy to miss someone who is breathing 25 times a minute if you don’t pay attention to it.   :29

Garibaldi says what is known is that very low oxygen levels are dangerous, so he urges clinicians to pay attention to more subtle signs of breathing difficulty. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Using ultrasound helps clinicians track status of COVID-19 infection in real time, Elizabeth Tracey reports

Ultrasound is able to detect lung and heart changes related to COVID-19 infection quickly and reliably, Johns Hopkins critical medicine expert Brian Garibaldi says. He points out additional advantages to the technique.

Garibaldi: You can do it multiple times. You can record your images, you can show those to other people so you can get advice in real time, hey, I just did this ultrasound of so and so’s chest can you take a look at it and let me know if I’ve missed something. You can also do serial exams so it would be really hard to get an echo every day on a patient but if someone’s having problems and you’re worried about their heart, or you’re worried about fluid collections around their lung or their heart, you can do a real time assessment every day, in minutes, to be able to follow the trajectory of that patient longitudinally.  :27

Garibaldi says images previously obtained with CT scans can now be gotten at the bedside, avoiding both transporting critically ill patients and the need to decontaminate the CT scanner, which brings the machine offline for quite some time. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can using ultrasound at the bedside improve care for COVID-19 patients? Elizabeth Tracey reports

Using ultrasound technology at the bedside of patients with COVID-19 infection is proving very useful in managing the disease. That’s according to Brian Garibaldi, a critical care medicine expert at Johns Hopkins.

Garibaldi: One of the advantages of ultrasound in the time of COVID-19 is that you’re going into the room anyway and you can bring in a portable device that’s easily cleanable to start gathering information that previously was only available to us through CT scan, which requires transportation of the patient out of the unit or echocardiography, which requires having another person come into the unit who otherwise wouldn’t be there, with a much larger device which is potentially more difficult to clean. So it’s really been an opportunity to start using ultrasound more broadly, to try to improve our infection control compliance but also to get information in real time.  :34

Garibaldi says ultrasound has been proving so useful that Johns Hopkins has purchased and deployed many of the devices to help clinicians deliver the best care to their patients. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Studies are pointing to blood vessel damage as a result of COVID-19 infection, Elizabeth Tracey reports

Children with COVID-19 infection may rarely develop an inflammation of blood vessels similar to another known condition called Kawasaki syndrome. David Kass, a cardiologist at Johns Hopkins, says this blood vessel issue that results in increased blood clotting is also found in some adults with the infection.

Kass: The study that came out related to the pretty rare inflammatory vascular disease in children is paralleled in a way by a case report in the New England Journal of five young adults who all presented with stroke. The most common presentation that we’re seeing is deep venous thrombosis. Fundamentally this idea that there’s a prothrombotic vascular inflammatory state that is occurring I think is becoming increasingly accepted.  : 31

Kass says clinicians are aware of prothrombosis or tendency to develop blood clots and there are medications to help. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Some people with conditions that need urgent medical care may not be seeking it, Elizabeth Tracey reports

Heart attacks and strokes seem to have declined during the COVID-19 pandemic, a look at emergency department data suggest. Yet a deeper look seems to suggest that people are simply choosing not to come to the ED, even when they have symptoms, out of fear of infection. David Kass, a cardiologist at Johns Hopkins, says you should seek care.

Kass: Providers have definitely established a remote telemedicine platform. You shouldn’t be sitting at home with symptoms that are concerning you, those mechanisms have to be used. If we use them appropriately, and they are widely available, through every network I’m aware of, then the probability of something really bad happening that should be avoided, despite the fear of catching something, won’t happen. Use that tool, talk to your doctor, don’t quietly have your chest pain because you’re afraid of catching COVID-19.  :32

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: When you consider personal choices in the pandemic, what should you consider? Elizabeth Tracey reports

If you’re older you’ve probably already heeded warnings about avoiding Sars-CoV2. Same if you have high blood pressure or heart disease. Now, even if you’re younger but obese, you may want to consider your risk from COVID-19. That’s according to research by David Kass, a cardiologist at Johns Hopkins, and colleagues from around the country, published in the Lancet.

Kass: There was a general sense, if you’re younger you’re probably OK. What our findings suggest is that’s probably not really the case. There are aspects independent of just the weight pressing on the lung that go with obesity that I think make you at somewhat higher risk: diabetes, hypertension, these are all risk factors for a virus that increasingly we’re finding is probably attacking blood vessels as one of its main actions.  :28

Kass says that if you are obese, exercising caution as states reopen, keeping physical distance between you and others, and employing public health recommendations is prudent. At Johns Hopkins, I’m Elizabeth Tracey.