Being a ‘happy hypoxemic’ and why ventilators weren’t always needed
May 13, 2020, 4:51 PM
(Senior Airman Jonathan Lane/U.S. Air National Guard via AP)
Have you wondered what happened to the crisis of ventilators? Suddenly, we have way more than we need and some doctors are finding out that they may not have to use them just because their patients seem to be low on oxygen. What changed?
“Normally what happens is when a patient shows up with low oxygen saturation, they are given oxygen. And if oxygen alone doesn’t make them better, that’s how they end up on the ventilator. This is why there was this need for all these ventilators because patients were coming in with low oxygen saturation,” said Tacoma MD Dr. Gordon Cohen on Seattle’s Morning News.
“So they’re saying that it’s somewhat of a paradox of having abnormally low levels of oxygen in their blood, combined with the ability to breathe really relatively easily,” he added.
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It’s sometimes referred to as being a happy hypoxemic. Because he works in cardiology, Dr. Cohen says he regularly sees patients with lower oxygen saturation as a result of heart problems or birth defects, which he works to repair.
“So we often send patients home after a first operation or before having an operation with a saturation of 75% to 85%. And we have lots of patients like that, and they do just fine,” Cohen said. “They go home, they grow, they thrive, they don’t have brain damage, and they come back.”
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“I think it’s interesting because this is something that I’m used to dealing with every single day. But I think that most adult physicians just aren’t aware of it because I’ve been in such a highly specialized field,” he said.
Based on his experience, if these doctors ordering the ventilators had consulted with him, would he have told them that low levels of oxygen saturation are fine and there’s no need for a ventilator?
“The question is can a patient with lower saturation who has some other acute illness recover? But if the patient is coming in with an infection but just has lower oxygen saturation and otherwise looks fine, I think that it’s probably OK to leave them that way,” he said. “The question is if they get more sick then do they need the higher levels of oxygen in order to fight off the illness?”
In a lot of cases, were ventilators being used unnecessarily?
“I’m not the one there and I think those doctors on the spot have to make that decision,” Cohen said. “Having said that, I think what they’re learning is that maybe they don’t necessarily need the ventilator. I think that it’s been dogma in adult medicine that patients can’t survive unless they have normal oxygen saturation.”
“But maybe what they’re starting to realize is what we already know in the field of congenital heart disease, that patients actually can do just fine with lower oxygen saturation.”
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