Eduardo Oliveira, MD, Intensivist and Pulmonologist, Advent Health System, talks about how using old techniques brought new benefits when treating COVID-19 patients.
I wanted to start with a very broad question. Can you tell me, for our viewers, what you and your colleagues looked at and tell me why you wanted to do this study?
OLIVEIRA: Sure. So what we decided to do before we were faced with the first patients in the pandemic is to have a well-defined plan to care for them. So what we decided to do was to get the best evidence that we had in the world literature as far as treating patients with respiratory failure and we decided to put into practice those protocols in a very systematic way. And we decided then to look at and prospectively look at this data or capture that data as we treated those first 1,300 patients that we’ve seen here at Advent Health.
Tell me a little bit about those patients. These were the patients that were in the ICU. Were they patients that were also on a mechanical ventilator? Can you just give me a snapshot of your patients?
OLIVEIRA: Sure. So we looked at all the patients that were admitted in the hospital initially, and then we concentrated on the 30 percent of patients that ended up in the ICU, about 300 to 350 patients. And the majority of those patients were mechanically ventilated, so those were the sickest of the sick.
Did you find any other similarities between their cases besides the mechanical ventilator?
OLIVEIRA: They were all, for the first wave, and these primarily were patients that we’ve seen on the first wave. They tend to be elderly patients, although we’ve seen patients on all age groups, and they had significant comorbidities or other illnesses that made them more susceptible to serious infections. The other thing that was pretty striking is that the disease progression, the way the disease developed, was quite quick in terms of their clinical course. Some of them were healthy two days prior and they were extremely sick when they arrived to the hospital and many of them had to be intubated immediately.
Did you and your colleagues then look at therapies and treatments to get a sense of what was used on this population of patients?
OLIVEIRA: We were constantly looking at reports at the time and studies being done either by industry, pharmaceutical industries, as well as groups, physician groups across the world, and we decided to pick the ones that were most promising at the time, like dexamethasone or prednisone and also tocilizumab, which is another drug that has been used in COVID, and we decided to either enroll patients in studies that were national studies that were treating those patients with those drugs or be driven by the physicians at the bedside.
Of the population of patients in this study, what percentage survived and what percentage did not survive?
OLIVEIRA: So of the patients that went to the ICU, about 70 percent of them survived. If you were on the mechanical ventilator, about 60 to 70 percent of them survived, which is a pretty good number -at least at the time was pretty good.
What did, after looking at all of this data, what did you and your colleagues conclude in terms of treatment?
OLIVEIRA: That’s a very interesting question. I mean, what we actually concluded, because none of what we had done was really what we would call rocket science or something that was truly innovative. What we basically did is treated them with the best available evidence for respiratory failure, especially for patients that were mechanically ventilated. As we looked at the best practices that we felt really made a difference in patient care were practices related to mechanical ventilation, minimizing harm, providing them with lower volumes of air as we are ventilating them, proning them or switching positions to better ventilate them, as well as having very well-trained staff or staff that were not only in numbers available to provide all those therapies because it takes about eight providers or eight health care providers to flip a patient to put a patient in a prone position. And you have to do that sometimes several times during the day. In addition, you have to have well-trained nurses, well-trained physicians that have the time and are in our ICUs caring for those patients. So staffing was a very big factor that I believe made this treatment approach successful.
For our viewers, again, who may be saying, well, this is on the wane, cases are down for COVID or even we’ve heard COVID is over. What would you say about the importance of having this information?
OLIVEIRA: The way I see the importance of this information is twofold. Number one is that we need to stick with best practices. As with any industry, you look at your best practices and try not to deviate from them. Even when there are unknowns, you apply the best evidence, and you make it fit into what the disease process is. Second, I would say that COVID is going to be here for a while. COVID will continue to be a problem. Obviously, we all hope it’s going to be less of a problem, but we’ll still have to deal with it for I believe, for years to come. Vaccination will be of great help to reduce the incidence of this disease. But even when COVID goes away, I am certain that we’re going to face similar situations in the future. And the learnings of this pandemic will be key on how we treat them effectively from day one.
How much of a difference did employing best practices make in the mortality of the patients?
OLIVEIRA: I think it’s key. I’ll give you an example. Of what we’ve done in -for patients that require mechanical ventilation with ARDS, for example, which is a very similar process to what the patients with COVID have, if you look at the evidence over the past 30 years, there was one thing that made a difference in mortality in patients with ARDS, and that was a protocolized way of providing mechanical ventilation by minimizing harm, reducing the amount of pressures that we give into a lung or that we subject the lung to as we are ventilating them. And that’s a process issue. It’s not a drug. It’s not a specific medication that we’re giving that saves lives. It is the process that we have to have in place to minimize the harm and support them through that period of mechanical ventilation, for example.
So I know our viewers have heard a lot about all of these different drugs that you mentioned what kind of impact did this have on COVID patients? Are you saying that those are not as effective or shouldn’t be standard of care?
OLIVEIRA: Those drugs, they are effective. I think that they do make a difference, prednisone, tocilizumab, antivirals, they do make a difference and I think that they are impactful. What I am saying is that, even before we get there, we just need to make sure that we’re practicing their standard of care and we do it in an organized way and we have enough staff trained staff to provide that kind of care. I would say that one of the main points that we’ve taken from looking at this data is that it goes back to what I said before, is just having and just practicing evidence-based medicine. I’ll get back to it because there was a lot of confusion at the beginning and people were trying new things. And they were trying, it’s a new disease. So, yes, there’s nothing wrong about trying new things as long as you are not doing in a way that is outside of a study. And if you’re not studying it, if you’re not doing it in a study format, you should be sticking to the evidence until proven otherwise.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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