Heavy Sedation Saved People From Covid–At a High Price

COVID patients survive, but it came at a cost. Being under it on heavy drugs for days or weeks has now left many of them with lasting physical and mental health impairments. I did not sleep well. I would get panic attacks during the day, and I didn't attribute them to PTSD or anything. I just figured I've been through this and now it's just sort of trailing off into the sunset. That's Kelly McCarthy. She spent weeks on a ventilator as a result of COVID and lived, but she

now faces a very different life. We'll hear more of her story a bit later. First, a conversation with Dr Wes Ealie He's a pulmonologist and critical care physician at Vanderbilt University Medical School, and he's seen up close the effects of sedation on patients. He's also the author of the book Every Deep Drawn Breath, A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the i c U. Doctor.

In the early days of COVID, very sick patients were going to the hospital and doctors were trying to figure out what to do. There weren't a lot of answers, and sometimes people were being very heavily sedated. You've spend decades studying the effects of sedation. Can you explain the difference between the proper use of sedation and when it's overused? Yes, you know, when you come in the i c U and you have to get life support like a ventilator.

It makes sense that as a doctor, I would want to provide my patient with a level of comfort that sometimes comes with unconsciousness, and so a sedative drug. But what we've learned over thirty years of research west thousands and thousands of patients and NIH and federally funded studies is that we can really cause a lot of harm to our patients. By giving them too much sedation for

too long. And so what we have done is randomized trials over the years where we've proven that people can actually be more likely to live on the back end of critically illness if we shorten the sedation, give them less and overall, don't burden them with drugs like benzo days appines, which were really common during COVID. Unfortunately, you worked as a critical care physician in those early days,

kind of scary. They weren't vaccines yet. What sort of practices did you see that you've now learned weren't actually best practices. I'm gonna tell you through the story of a patient. I had a patient named Teresa Martin, and

I have permission to use her name. In nineteen ninety I cared for her with a pattern of sedation which was heavy and mobilizing and put her in a coma for many days, And then for the next twenty five years I did research to try and figure out, with the rest of us around the world, how do we keep people more awake, more learned, more in communication with their family members, and earlier mobilized. And we had made all this progress until twenty nineteen, we had more people living,

they were living with less disabilities, et cetera. And then COVID hit West. I'm standing in the ICU in the COVID I C you caring for a man named Fred Reyes also have permission to use his name, and he was on the ventilator, and I thought to myself, Oh my gosh, this is deja boo. I'm back in Teresa Martin. We have regressed thirty years in our practices, and that's

exactly what happened globally. We proved in a study of two thousand one COVID I SEE patients that we were over using benzos and under using family and this was creating a massive amount of a cute brain dysfunction and accelerating death during COVID. You said you were over using benzos, these very powerful sedatives and under using families. What exactly

do you mean by that? The best way to keep somebody's brain online or on track when they're critically ill is to give them a little bit of sedation at

the beginning on the ventilator. We do need sedation at the beginning when we first put somebody on the ventilator, but it's on day two or day three or day four where we need to be waking people up every single day to allow them to look in the eyes of their wife, their spouse, their husband, whatever it may be, so they can remember, oh, I have a reason to live.

And they're getting by with a very scary how in the I c U. They have lions and tubes and they can't talk and they need to see their family and they to be able to process that well. During COVID we pummeled them with benzod a zapines. There was a paper early on in the New England Journal of Medicine. They showed that eight six percent of COVID patients were getting benzoda zapines like at a van or medaisa LAMB. And just prior of COVID we had pretty much gotten

rid of those drugs altogether. They caused a tremendous amount of delirium and harm and so we don't like to use those on people. And so why were they used so frequently in COVID. Why did they bring these drugs back? What was it about COVID care that sort of threw the rule book out the window. Just prior of COVID, we had a safety checklist in the I c U. It's called the A D C, D E F bundle. We called the A T F bundle. That essentially was waite people up, get them out of bed, and have

their family there. Well. At the beginning of COVID, when I wasn't vaccinated and no one else was vaccinated, were afraid to have family members come in, so we kept family away. We kept the patient in the room, We shut the door, and we had the patient behind the glass.

They had a tube down their throat, so to make them not able to pull that tube out and take themselves off of a ventilator, which we call self excavation, we snowed them with benzos because they are the deepest coma laden drug that we could give them, and also the drug probofall those were the drugs that we were using because we had to keep the person so deeply in a coma, since we weren't free to go in and out of the room as much as we wanted to.

When that happened, family members weren't allowed in. Doctors and other members of the care team weren't able to check as frequently. What did we learn about what the effects were both for the treatment of COVID and after people recovered, we were doing the best we could with the light we had at the time. Now we know that vaccines work and that personal protective equipment PPE works. It was anti medicine. It was a time when we couldn't have

the families there. But what we learned were two main things. When we put all those COVID patients deeply indetective coma like we had been back in the ninety nineties, it increased dementia. It increases a problem called post intensive care syndrome, which is p I c S or the so called PICKS. And on the back end of the ice use day, if somebody survives, what they land with in their life is big time cognitive impairment, memory impairment, the inability to

do their job. They also have way more in the terms of muscle and nerve disease, and then more depression and post traumatic stress disorder our PTSD. So we were exacerbating, if you will, the likelihood of them getting post intensive care syndrome and having all these disabilities in the months and years after they tried to recover from their COVID. So for decades you have studied this. You actually wrote the rule book when it comes to how to properly

sedate patients with other physicians you work with. Knowing what you know now from the experience treating and sedating COVID patients, have you changed the rules are added to them in a way using this experience to improve care in the future. We absolutely have. What we have done is we have said, Okay, we don't need to start from scratch. We have twenty five years of randomized control trials and Cowork studies. We

don't have to start over. So what we've done is we've worked nationally and internationally with intensive care societies and we're taking the abc DF bundle, the hwo F bundle, and we're re implementing it on a large scale all over the world to say, the next time we have a pandemic like this, we are going to make sure that we do not abandon all of this data which we know saves lives, produces length of stay, cuts down cost of care, and helps people survive without an acquired dementia.

And so that's what we're doing to move forward both currently in the Perry pandemic period of COVID, because there's still hundreds of people in the i c US with COVID right now, although the numbers are way down and we're gonna have another pandemic, we just need to make sure we do it more safely next time. So dr we're talking about COVID in a possible future pandemic, but

just in normal life. If one of our listeners, a member of their family falls ill and requires sedation and they're in the hospital, what can people do to make sure that the sedation they're getting does follow these rules and that they're going down the right path instead of a less fortunate one. First of all, if you are with a loved one who is in the I c U and on a ventilator, then you are their advocate. And I want you to know that it is okay to be their advocate and to request to be present

at the bedside. These days of limited visitation should be over, and they are wrong, and you should challenge that and say I need to be with my loved one because they need an advocate and they need to make eye contact with me so they can remember that they have a why to live. We aunt heal people West with just science. It's over. We know that we have to have humanism and science We need physical touch and that personal humanistic approach plus the science. That's how we completely

heal human being. So that loved one should say, I want to be on rounds. Let me listen to what you're doing and give me a lay explanation of what's happening. I will tell you what my loved one needs. I know what matters to them, and I call this West flipping the preposition. It's not just about what's the matter

with someone, it's what matters to someone. So I have to have the family members there with me to tell me what Mr Smith, what's important to him, and how far I should push different types of interventions, how aggressively I should make that wakes up every day. Should we try and get him hearing? His granddaughter today is she's the most important person who's gonna help him? Have you know the reason to live. We're gonna take this humanistic approach and put it alongside the science, and we need

the family there to make that happen. Dr wessey Elie, thanks so much for talking to me today. My brother styke you travling after the break the widespread effects of heavy sedation on patients. Bloomberg Senior Editor and Biosecurity correspondent Jason Gale joins me now from Melbourne, Australia. You have written this very interesting story about what's really a side effect and very serious one of COVID treatment, especially in the early days before the vaccine, when people were sedated

and often sedated to keep them on ventilators. You writing your story about a woman named Kelly McCarthy. Can you tell us about her? Kelly McCarthey is a woman now fifty two years old. She's a grandmother. She was previously working full time as an insurance claims adjusted just outside of Boston. She got sick with COVID in early one was actually around the peak of the pandemic, the pandemics

first went away in the US. I remember I was feeling very crummy, you know, just like a regular bug or something, and so I went and I got soup and whatever's just I was going to nurse it on my own. Finally one day I'm just like I can't get out of bed, and my husband comes in. It goes you go into urgent care if I have to throw you over my shoulder. So we did, and my oxygen, I guess was like in the fifties somewhere it's supposed to not go blow ninety and um, yeah, and everyone

in the room went, so I knew it was bad. Um. So then they took me to the hospital and I was in the ICU for like, I want to say, like three days. Very quickly they worked out that she had COVID and tried to give her a supplemental oxygen, but after a few days they realized that she needed to go into a mechanical ventilator. I was intubated twice, and they tried three times to excavate me, but I guess I started getting really agitated and swinging and trying

to whatever. So then they decided to do a tricky as to me. Yeah, so my little bar fight scar. But the they just said, we can't keep doing this and her lungs won't work on their own. And that's when they started working on my family, saying she's going to be hooked up to something for the rest of her life. And the only thing I had was some extra oxygen when I got home, so that was nice.

We think of people when they're sedated as being asleep, but what you describe that Kelly McCarthy and other patients experienced is this sort of sleeping wakefulness where they were aware they were having really bad dreams and they could feel themselves fighting the ventilator despite the sedation. So sedation isn't exactly sleep and the way we are sleep, It's really an altered state of consciousness. So in the case of Kelly McCarthy, she was given multiple different agents fastidation

for pain relief and to essentially paralyze her. There were periods over the many weeks in which she was on a mechanical ventil later and which she was not asleep, and she was kind of conscious of things going on around her, and it fed into her consciousness, and she essentially studied hallucinating. All kinds are different, sometimes horrific things. While I was under, I had the most horrifying nightmares, but I wasn't like all the way under, so reality

was working its way into into my dreams. Like I was in a room and like a hospital room, go figure, and the doctors like, hi, Kelly, do you know me? I just intibated you whatever. And I looked at her and she she said, um, okay, so I'm going to kill you in my drink. I've doubt she said that

in I See You. One of the other ironies of this story is that these treatments, though some of them were very difficult for the patients, led to a higher survival rate than we've seen in previous pandemics, certainly influenza pandemic, and so the very thing that kept them alive is something that has pointed up big problems with people being

heavily sedated. Yeah. Absolutely, we are now dealing with the after effects of so many people, at least a quarter of a million patients in the US, who survived their intensive care for COVID, and a majority of them will have some degree of impairment following that. I don't drive at this point because if my legs are kicking out from underneath me, I don't want them kicking out behind

the wheel because that could be a real problem. I forget things, and so that's difficult because literally I'll be like, oh, I got to look that up on Google, pick up my phone. I have no idea. Apparently it was a terribly important But stuff like that, holding things without dropping them, that's that's fun. So but only if my hands get

to like that. They gave me surgery. I had carpal tunnel in both hands from the fluid that they filled me with, and I guess it impinged the nerves and because of that I got I mean, my hands hurt so much at the time and it couldn't feel them. So the impairments really go from the head to the toes. It's all kinds of things. There's mental cognitive impairments to do. Obviously, with the brain, there is often long scarring, muscle weakness,

dental issues. Often um patients it's hard to clean their teeth, for example, patients can get bed sores. They essentially get what's called post intensive care syndrome, and that is this sort of umbrella term for really a large raft of problems that can be quite enduring. My conversation with Jason Gale continues after the break. Jason, you write in your story that even though Kelly is grateful to be alive, her life is now entirely different than it was before.

It really is. Her daughter Rachel mentioned that she was previously working multiple jobs, working sometimes seven ninety hours per week. She's now unable to work at all, and the outlook for her working isn't good. And this is a woman who isn't her early fifties. She didn't expect to have to retire so young. It's just the isolation. It's not even the financial you know, because we do all right,

so that's fine. But it's like I would go to work every day and see my friends and enjoy them and chit chat and talk to people and do my work or whatever. I don't have that anymore. I don't go out really. I mean, I'll go out to see my my kids, my grandkids, whatever, um, run errands, but since I don't drive, and I've got to wait for right. So it's had a profound effect on her professionally, but even you know, socially and economically. Uh, and not just

not just Kelly, but the rest of the family. Um, it has affected me. That's Kelly McCarthy's mother, Brenda Reid. I still get choked up. But what I find is I can be driving along in the car and you know, just listening to music that has nothing to do with anything, and all of a sudden it will hit me and I will feel very sad, only for a moment, but there's still those little flashes, and um, I suspect those

will go on for a while. I don't know how long, but it says to me that if something like that is affecting me, I can't even begin to imagine how it must be for the child, the woman who went through all of this first person. And I think it's important to note that when a patient does spend a lot of time in the I c U, the flowing effects across families is quite profound. A study from France showed that about a third of relatives of I SEE

COVID patients suffered PTSD as a result. And in the case of Kelly McCarthy, the woman you read about in your story, she was thought to be dying and the medical team called her family to say it may be time to say goodbye, and in fact her life was

saved by reducing the amount of sedation she was on. Yes, so initially Kelly McCarthy was treated in a county hospital essentially, and her acute respiratory distress syndrome just got worse and worse to the point where it looked like her respiratory failure would become fatal, and so her family was called

in to say goodbye. We did go and see her, we did say our goodbyes, but I told her to hang on because we were working on something that um would be beneficial to her, and she couldn't hear She couldn't hear us, so we didn't know if she could hear us. As I say, she was unconscious. Around the same time, Brenda, Kelly's mother, learned that double lung transplants were occurring and may offer some life saving benefit for Kelly, and so calls were made to the Brigham and Women's

Hospittle in Boston to have Kelly transferred. I had seen a story where at Brighaman Women's they had a lung center and there was a man I believe it was from Nebraska, had come in. Both lungs were gone because of COVID that he had transplants. He survived. He was home in Nebraska doing quite well and recovering, and so we said to the doctor, we want to transfer it. I spoke to Daniella Lamas, an intensive care doctor who took over Kelly's care, and she realized that Kelly's lungs

weren't the main problem. She just as Danielle Lamas said, needed to have her sedation turned off or turned down slowly, and over the course of the next week or two, they did tie trade down all her sedation and opioids and things, and eventually she was able to come off the mechanical ventilator. What do you take away from all this about the lessons that have been learned from this and how in the future the harm that can come from this sort of treatment the well intended can cause.

So talking to a lot of folks working in i c u s in different capacities, it seems as though we can never not allow family he gives back into the i c u s. That we need to figure out a way of keeping that and very important component of intensive care back in the i c U. So that is something that we've really learned from this pandemic, that it's so important to keep family members there in the room with patients. She's just a funny person, but

a sensitive person and a kind person. And I watch her now and I always know she was strong and brave, but I watch her now as recovery continues, but at a snail's pace, unfortunately, and the recovery in the end

may not be exactly what she had hoped for. But she's doing better now than she was in the beginning, and her her sense of humor does bring her through, but she It's funny because there'll be days when I'll be talking to her and she's very bubbly and upbeat, and I'll say, Okay, you're having a bad day, aren't you. And she'd say, why, why do you think that? I said, I'm your mother, and when you're upset, you're extremely bubbly and outgoing. And she went, yes, I guess I'm having

a bad day. So they are in there, but she's her coping mechanism is positively amazing. You can read Jason Gale's story about COVID and sedation at Bloomberg dot com. Jason Gale, thanks so much for taking the time talk to me. Thanks for having me West. It's good to talk to you. Thanks for listening to us here at the Big Take to daily podcast from Bloomberg and I Heart Radio. For more shows from my Heart Radio, visit the I Heart Radio app, app podcast, or wherever you listen.

Read today's story and subscribe to our daily newsletter at Bloomberg dot com slash Big Take, and we'd love to hear from you. Email us with questions or comments to Big Take at Bloomberg dot net. The supervising producer of the Big Take is Vicky Burgalina. Our senior producer is Katherine Fink. Our producer is Frederica Romaniello. Our associate producer is zenib Sadiki. Hilda Garcia is our engineer. Original music by Leo Sidrin. I'm West Kosova. We'll be back tomorrow

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