Becker's Clinical Quality & Infection Control

15 PATIENT SAFETY Use ventilators sparingly for COVID-19 patients, researchers warn By Anuja Vaidya A dopting a new playbook for deciding when to ventilate COVID-19 patients and using ventilators for these patients less often could help reduce the death rate among this population, according to research published in the American Journal of Tropical Medicine and Hygiene. e research summarized existing guidance on best practices for providing ventilatory support as of late April, with a focus on resource-limited settings. The researchers said invasive mechanical ven- tilation should be used for COVID-19 patients struggling to breathe. But patients with hypox- emia, or low blood oxygen levels, should not be rushed onto a ventilator "because hypoxemia is often remarkably well-tolerated," in COVID-19 patients, they said. Unlike in patients with other forms of pneu- monia or sepsis — where low blood oxygen levels cause the patient to gasp for breath and limits their ability to speak — COVID-19 patients with low blood oxygen levels do not show as many signs of respiratory distress and are even able to speak in full sentences, according to STAT. The authors said COVID-19 affects patients' lungs differently than other causes of se- vere pneumonia or acute respiratory distress syndrome. Many COVID-19 patients develop a thick coating in their lungs that limits their ability to take in mechanically delivered oxygen, STAT reported. Damaged areas and healthy tissue can sit side by side in the lungs of COVID-19 patients, they said. Delivering oxygen-enriched air to the healthy tissue at high pressure and in large vol- umes can cause further damage, such as leaks, swelling and inflammation, the researchers said. "Invasive ventilation can be lifesaving, but can also damage the lung," study author Marcus Schultz, MD, PhD, a professor at Amsterdam University Medical Centers, told STAT. n Maryland nursing home fined $10K a day after COVID-19 deaths By Mackenzie Bean H ealth officials are fining a Maryland nursing home $10,000 a day for infection control deficiencies related to a COVID-19 outbreak at the facility, according to a notification letter obtained by The Washington Post in early May. Thirty-four residents and one staff member at La Plata-based Sagepoint Senior Living had died from COVID-19 as of May 9, marking the highest death toll of all nursing homes in the state. In a May 6 letter sent to the facility, health officials outlined various de- ficiencies they discovered during an inspection, including failure to use personal protective equipment and failure to separate residents known or suspected to have COVID-19. Maryland's Office of Health Care Quality is fining Sagepoint $10,000 per day until the nursing home complies with all state regulations. The daily fine took effect March 30 when the inspection began. Sagepoint leaders said they strongly disagree with regulators' findings and plan to dispute them, according to Joyce Riggs, a spokesperson for the facility. "We feel it would be inappropriate and highly irregular to respond to last night's letter in the media before we have followed the proper process," she told the Post. As of May 19, it was not immediately clear whether the fine had been lifted. n Study: 88% of COVID-19 patients on ventilators died in New York By Anuja Vaidya A bout 12 percent of COVID-19 patients in New York received inva- sive mechanical ventilation, and most of them died, according to a study published in JAMA. Researchers analyzed EHR data for 5,700 COVID-19 patients at 12 hospitals in New York City, Long Island and Westchester County, N.Y., all part of New Hyde Park, N.Y.-based Northwell Health. The patients were admitted to hospitals between March 1 and April 4. Researchers assessed outcomes for 2,634 patients who were discharged or had died by April 4. Of these, 14.2 percent were treated in the inten- sive care unit; 12.2 percent received invasive mechanical ventilation; and 3.2 percent were treated with kidney replacement therapy. Twenty-one percent of the patients died. Of the 320 patients who re- ceived invasive mechanical ventilation, 88.1 percent died. Among the 5,700 patients studied in total, the most common underlying conditions were hypertension (56.6 percent), obesity (41.7 percent) and diabetes (33.8 percent). The median age of the patients was 63 years, and 39.7 percent were female. Forty-five patients (2.2 percent) were readmitted during the study period. n

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