8 a.m.: COVID-19 Unit, St. Joseph Hospital, Denver

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Kelley Griffin, CPR News – cpr.org

Dr. Peter Stubenrauch reviewed patients’ charts with his medical team during morning rounds and once again weighed the tradeoffs of long-term ventilator use. 

Patients getting high levels of oxygen usually are placed on their stomach to ease pressure on the lungs. But that leaves them vulnerable to skin damage as they rest on tubes and equipment. 

“Unfortunately, it comes down to an intellectual discussion between how sick are their lungs and how worried are you about the skin,” said Stubenrauch, a critical care pulmonologist with National Jewish Health, which staffs and manages the ICU. “But ultimately the skin wounds should recover (and) we need people oxygenating well enough that they’ll hopefully recover from this from a lung standpoint, too.”

Nearly every patient in the unit was on a ventilator, that precious piece of equipment that can be the difference between life and death during the coronavirus crisis.

The medical guidance on COVID-19 is evolving fast. Stubenrauch said doctors use the “tried and true” approaches to respiratory illness and are eyeing experimental treatments being developed. He recommended that one of his patients be added to a promising drug study. If she’s accepted, she could get the drug or a placebo the research requires. He can’t know. 

Consultations with families are done by phone. Discussing life and death matters but not face to-face, with family members who can’t even be together with their loved one, is heartbreaking. And the uncertainty about COVID-19 means preparing families for the worst.

“You by no means have any interest in giving up on a patient, particularly someone who came into the intensive care unit relatively recently,” Stubenrauch said. But he must “also set the expectation that we’re observing a lot of patients who remain on mechanical ventilation for prolonged periods of time and can quite suddenly take turns for the worse and pass away.” 

By his shift’s end, the news in the unit was brighter. There were no new admissions for the day.