Looking at the number of deaths in northern Italy and listening to the continuous requests for

mechanical ventilation machines (1) and for extracorporal membrane oxigenation (ECMO) devices (2) now the time has come to realize that ICU-admission and intubation of all COVID-19-patients with acute respiratory problems very often is not saving lives. The use of prognostic scores (3) may be used to avoid ICU-admissions.  CT-scan of the chest and repetition of this procedure(4), however, is often not helpful and even dangerous as contrast medium is needed which may damage the kidney and augment blood volume. The report published by Arentz et al (5) clearly show that more than 50% of COVID-19 positive patients with severe comorbidities die shortly after ICU-admission, the other 50% continues to need mechanical ventilation.This severely reduces the ICU-capacity. A careful selection of ICU-admissions is necessary (6).

As suggested by Dr Bonazza (7), treatment of  patients with severe comorbidities should  better be treated with non invasive ventilation (NIV) (6).The questions asked by Dr Olgiati (8) are very appropriate. In fact many people believe that intensive physical exercise can only be healthy. This is not always the case (9), especially when„little“ viral Infections (e.g.common cold) are ongoing.

The answer to the third question is clearly affermative.This is even more approrpiate if we presume that many patients in home quarantene continue to smoke cigarettes.

 

REFERENCES

 1.Murthy S, Gomersll ChD, Fowler RA.:Care for critically ill patients with COVID-19.JAMA 2020  March 11

2.McLaren G,Fisher D,Brodie D.:Preparing for the most critically ill patients with COVID-19. The potential role of extracorporal Membrane oxygenation.JAMA 2020,February 19

3.Wujtewicz M et al.: COVID-19-what should anaesthesiologists and intensivists know about is. Anaestheiol Intensive Ther.2020;52:1-8

4.Wang D et al.:Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan,China.JAMA 2020 February 7

5.Arentz M et al.Characteristics and Outcomes of 21 critically ill patients with COVID-19 in Washington state.JAMA 2020 March 19

 

 

 

6.Sun Q,Qiu H,Yang Y.:Lower mortality of COVID-19 by early recognition and intervention:experience from Jiangsu Province. Ann Intensive Care 2020; 10:33

7.Bonazza P.:What about Non Invasive Ventilation in ICU/Sub-Intensive Units . Grasselli G,Pesenti A,Cecconi M :Critical Care Utilization for the COVID-19 Outbreak in Lombardy, ItalyEarly Experience and Forecast During an Emergency Response.JAMA 2020,March 11.

8.Olgiati S.:Behavioural factors; clinical COVID19

exacerbation,prevention and recommandations.Grasselli G,Pesenti A,Cecconi M.:Critical care utilization forthe covid-19..JAMA2020,March 11

9.Morici G et al.Endurance training:is it bad for you? Breathe 2016;12:140-147