We talked about Midazolam.

Another perspective from Dr Pierre Kory, on the front line.

I recently shared the open letter from Doug Brodie to his MP in Scotland, asking him to address 20 key points suggesting that the whole COVID response is responsible for substantially more harm than the virus itself.

Point 4 in that letter related to the use of Midazolam (in the UK). Dr Mike Yeadon has also made very strong, similar claims:

We need to talk about Midazolam.

However, this prompted Dr Pierre Kory to contact me to offer a rebuttal to these claims. It should be given serious consideration given his frontline experience and the enormous sacrifices he has made in calling out other aspects of the appalling COVID response.

Shared with his permission:

As an ICU doctor who has cared for many COVID patients on ventilators, I don’t agree that midazolam and morphine was used with ill intent at all. We used a ton of it for sure, but for a simple reason - many patients landed on ventilators, and when they did, they were very hard to manage on the ventilator due to altered respiratory mechanics and also encephalopathy - they breathed so fast and with a lot of patient-ventilator desynchrony that the only recourse was deep sedation to make them comfortable and to prevent worsening of ventilator induced lung injury (VILI). Many of us in the ICU were shocked at how much sedation they needed, especially during the first wave, and we were forced to use paralytic infusions way more often than is typical for most acute respiratory failure states. Note that morphine/fentanyl/midazolam/propofol infusions have been standard practice for ventilated patients for decades and I worry that the way you argue Point #4 might detract or call into question every single other extremely well argued point, so I thought I would reach out to help correct in some small way.

Now, issues around CPR policies and “early ventilator” practices is a little more complex but, as a guy on the inside (or was), I would argue they were done out of fear and stupidity, not malfeasance. Docs were told to be scared of “sudden deteriorations” into acute/severe respiratory failure that they often (and stupidly) opted for early intubation to avoid putting someone on a ventilator in acute distress/near-arrest states (intubating someone in advanced hypoxia/distress becomes much more challenging). Fun fact: I was the Chief of the Critical Care Service at the University of Wisconsin in early COVID and many of the intensivists on my service, and many anaesthesiologists wanted me to make a policy for early intubation, and I refused! I told them that we should not change our decades-long practice in acute respiratory failure which is to intubate “not too early and not too late” (a goal that has challenged me during my whole career). If anything, my tendency has been to intubate later than I probably should have (at least I always felt this way afterwards), and I have worked with and trained docs who I felt had a tendency to do it too early, but it is a challenge for all ICU docs. So, at Univ. of Wisconsin, we did not do early intubation but many centers did initially until they figured out that many patients just needed high fractions of oxygen and not a ventilator, after which point early intubation stopped (not everywhere but largely). Anyway, I hope this helps, again appreciate all your thoughts and work.

Pierre Kory