PJYoung said:
Here's a TexAgs post from another thread:
Quote:
Marcus Aurelius
8:09p, 3/11/20
AG
I have a surgeon buddy who works at a hospital in Arkansas. Tells me they had a 30 y/o admitted with ARDS/respiratory failure. Long hospital course. Eventually expired. Family requested autopsy. Path report - ARDS due to, you guessed it, coronavirus. Not tested because lack of "travel hx/exposures." Egregious to me. Innumerable exposed there.
Healthy, no comorbidity. Died last week, autopsy posted yesterday. Not in the news or US statistics yet.
While this is unfortunate and certainly a sad case, in my mind, at this time it is more the exception than the rule, especially with the data gathered thus far. ARDS is not a unique consequence of COVID-19, in fact it has a multitude of potential inciting events, most commonly are bacterial pneumonias, viral pneumonias, medications, or environmental toxins, just to name a few. I recently had a healthy, 30-something year old female with no past medical history quickly progress to respiratory failure due to influenza, which she had contracted from her significant other who recently completed Tamiflu maybe a week earlier. Within 72 hours of presentation to the hospital she was intubated and eventually died due to ARDS stemming from influenza.
Generally in ARDS, following an inciting event, there is widespread inflammation that targets the thin membrane in our lungs that facilitates gas exchange. This leads to profound hypoxia and quickly progresses to respiratory failure requiring intubation. The unfortunate part about ARDS is that although these patients require mechanical ventilation to maintain oxygen levels, mechanical ventilators can actually worsen the hypoxia and possibly kill these patients. This is because ARDS causes changes that make our lung tissue very heterogenous, with certain areas very fragile that are damaged by positive airway pressure utilized in ventilators. Honestly, medicine does not understand ARDS very well, and when someone progresses to it providers usually will end up throwing the kitchen sink at them, regardless of it is COVID-19 related or not. ARDS carries a grim prognosis, regardless of how healthy you are. Quickly referencing some of my old lecture materials, roughly 80% of patients who meet ARDS criteria require intubation and it carries a high mortality rate (~30-45%).
So, although unfortunate and scary, I am not surprised that there are cases of young patients dying from COVID-19 due to progression to ARDS. ARDS is scary because it can affect anyone, and the treatment for it (which is primarily supportive and treating the underlying cause) can actually cause you to worsen. But whenever I hear of a younger/health patient with COVID-19 who dies, I immediately assume it was likely due to ARDS, or some other type of organ failure (either sepsis or particularly a viral-induced cardiomyopathy). I suspect that as the virus continues to spread throughout the world there will be a coinciding proportional increase in young/healthy patients that may progress to ARDS. Overall I hope this remains the exception, but what would be more concerning to me is if we started to see increasing numbers of severe cases/death of COVID-19 in young/health patients.
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