Ventilator Assisted Pneumonia (VAP) in COVID Study
Ventilator Assisted Pneumonia (VAP) in COVID Study
I have seen a couple of substackers go down a rabbit hole on this so will add my 2 cents .
Ventilator Assisted Pneumonia (VAP) in cohort study of 585 mechanically ventilated patients with severe pneumonia and respiratory failure,
https://www.jci.org/articles/view/170682/pdf
The study states Mortality is similar in patients with severe SARS-CoV-2 pneumonia compared to patients with pneumonia and respiratory failure secondary to other etiologies. But COVID patients do worse with unresolved VAP , and develop unresolved VAP almost 6 times frequently than non-Covid patients.
19.5% of ventilated patients with COVID developed unresolved VAP which increased mortality or hospice rates from 17% to 76%.
The mortality rate of successfully treated VAP is the same as those without VAP for both COVID and non-Covid, although the rate of VAP is over 2 times that of non-Covid patients
Thanks to this MSM Science Article many are being led down a rabbit hole
The Headline is incorrect. The study did not say MOST Covid Deaths are due to unresolved VAP , and even the article explaining the study says no such thing
The study does say that of the 19.5% of ventilated COVID patients who go on to develop unresolved VAP, 76% will die or end up in hospice vs 17% whose VAP was successfully treated.
Now if you do the math , 52% of mortality (death or hospice) in the ventilated COVID patients came from the unresolved VAP group. But not all COVID deaths are from those on a ventilator, let alone those with unresolved VAP. I will discuss more below.
The author of the article did state one untruth.
The findings refute the idea that a cytokine storm following COVID-19 – an overwhelming inflammation response causing organ failure – was responsible for a significant number of deaths. There was no evidence of multi-organ failure in the patients studied.
The study refutes no such thing.
Those with unresolved VAP are on a ventilator for long periods. The absence of multi-organ failure indicates cytokine storm was unlikely to be the cause of death. This does not mean the patient did not have cytokine storm at some point, but that if they had it it was already resolved through prolonged use of steroids
One interesting thing about the study was it indicated mortality rate of ventilated COVID patients was effectively 17%. This is a far cry from the 90% mortality rate in April 2020 when steroid use was discouraged.
Doing a bit of research I find as long ago as May 2020 some were reporting mortality rates of 30%. Steroids and Remdesivir came to be part of Standard of Care in May 2020
May 2020
The mortality rate among 165 COVID-19 patients placed on a ventilator at Emory was just under 30%.
Then again I have seen other reports putting the numbers at 50%.
The other thing that is important to note, as I mentioned above, is that not all of those who die of COVID are on a ventilator.
According to CDC data only half of COVID deaths had pneumonia
Only 5-15% of hospitalized COVID PATIENTS end up on a ventilator (likely lower number during omicron), falling from 25-30% early in the Pandemic
So a significant number die before making it to a ventilator and may die of other causes than respiratory failure (heart attack, stroke, etc), or they die on the ventilator without VAP.
Its worth contemplating why VAP was more likely in those with COVID than non-COVID patients. It was 25.0% among patients without COVID-19 compared to 57.4% among patients with COVID-19, and unresolved VAP was 6 times that of the non-Covid group (19.5% vs 3.5%)
This makes me wonder if Remdesivirs antiviral properties are affecting the virome and creating an environment conducive to bacterial growth, and perhaps making it more difficult to treat?. Not an expert so can’t say.
Don’t hold your breath for the FDA to investigate.