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Top doctor’s leaked memo reveals concern over coronavirus treatment approach

“Less aggressive” use of mechanical ventilation recommended

06 April, 2020 — By Tom Foot

Proning patients ‘very effective’ advises top boss 

A LEAKED memo appearing to come from the top boss of the Royal Free Hospital’s intensive care unit has revealed how initial approaches to ventilating coronavirus patients could be “harmful”.

Dr Dan Martin, OBE – intensive care lead for high consequence infectious diseases at the Hampstead NHS trust – reported back to colleagues about a teleconference with around 80 other experts in the field.

They were discussing experiences and how best to manage the new NHS Nightingale Hospital in east London.

The memo, seen by the New Journal, revealed how the practice of proning – where patients lie on their fronts while receiving oxygen – had been “very effective” and was now considered “essential”.

It added:

– Early high PEEP [a mechanical procedure used during the ventilator process] “is probably not the right strategy and may be harmful”;

– “Avoid spontaneous ventilation early in ICU admission as also may be harmful”;

– “There some evidence of early pulmonary fibrosis reported from Italy, possibly oxygen related”.

– “Proning is essential and should be done early”.

Proning patients on ventilators  “was very effective”, said Dr Martin’s memo, it added: “The take home message is that advice given at the beginning of this journey needs to be adapted as we learn more about CV19.

It added: “Whilst we may have a shortage of ventilators, holding people indefinitely on Continuous Positive Airway Pressure [ ventilator] may be short-sighted as it may be converting single organ failure into multiple organ failure.”

Dr Martin said his conclusions were that there should be “less aggressive”  use of mechanical ventilation for patients on admission to the ICU.

In terms of the amount of fluids given to patients, the memo said “all centres agreed that we are getting this wrong”.

There was a danger the service could “run out of machines” and that one support worker was needed to look after each coronavirus patient.

It was “unacceptable” non0medical staff at the Free had refused to help in the intensive care unit (ICU), the memo said.

“Last time I was on a night shift, theatres were full of non-medical staff refusing to help ICU – this is unacceptable.”

Many medical students and retired NHS workers have been thrust out of their comfort zones into the front line at NHS hospitals. But the memo said “training has largely fallen by the wayside as it is too large a task”, adding: “People are being trained on the job.”

“My conclusions after each section are nothing more than suggestions to be discussed. We need to adapt fast to what we learn about this disease and learn from our colleagues at other centre. We are all in this together and joined up thinking is required.”

The New Journal has tried to confirm details of the memo with the Royal Free NHS trust.


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