How do these findings affect patient care?
They’re having a big impact on patient care; they’re helping us to identify which patients are likely to do the worst and need the closest monitoring. This, in turn, helps front-line healthcare workers make vital decisions.
We’ve also implemented a strategy to prone intubated patients, to put them on their stomachs, when necessary, because it changes the dynamics of the lungs, alleviating pressure and increasing blood flow. Reports in other countries have proved this to be very effective for obese patients. Most intensive care units in the U.S. have not routinely proned patients, but now with COVID-19, everyone is doing it because it makes a difference.
What are other research findings?
In terms of obesity, the findings are pretty consistent here in the United States. We’re continuing to closely watch data from countries like China, Korea, Spain, and Italy. However, none of those countries has the prevalence of obesity that the U.S. has. So, it remains to be seen whether we’re going to have a higher mortality rate in part because of our much higher prevalence of obesity.
Did this research have any limitations?
We were not able to include mortality rates and outcomes in this report because a lot of patients who are intubated remain on a ventilator for a long, long time. Three weeks is not uncommon. Many of the patients in our registry are still on ventilators, and we don’t know what their final outcomes will be.
Are there plans to expand this research?
Yes, absolutely. We’re continuing to add patients to the registry, which currently has over 4,000 patients, and we are in discussions with NewYork-Presbyterian/Columbia University Irving Medical Center on how to conduct analyses in collaboration with them. A large Columbia team, also with medical students doing the bulk of the chart abstraction work, is using the same instrument we are, which will facilitate collaborations.
We’re also finalizing another analysis to help physicians identify the most at-risk patients and make decisions accordingly, based on the data. Decisions such as who needs a continuous pulse oximeter, which measures oxygen and heart rate, can be guided by the patients who are likely to do the worst and need the closest monitoring.
What can we learn from these data?
That more research is needed. There’s a large group of physician investigators who are very interested in advancing knowledge for the rest of the country, so this is really just the beginning. More studies will be coming out in the near future.
The paper and full list of authors can be found here.