Debate about ventilators

[Colin L]

"The death rate for those treated on ventilators is devastating. In one British study of 98 Covid-19 patients who were put on them or on similarly invasive breathing-support equipment, two-thirds died, according to a new report by our Intensive Care National Audit and Research Centre.

In New York, which has been hit particularly hard by the virus, 80 per cent of ventilated patients failed to recover. The loss of life in other countries for those on the machines is equally terrifying. "
I wonder if this is due to the fact that they are far more seriously ill than those not put on ventilators?

Also, what would have happened to the one third of patients who recovered had they not been on a ventilator?

 

[Blue in Munich]

Review the highwire video, but be warned Del Bigtree is anti vaccination and not seen as credible to certain medical sources.
However there are a number of medical papers referenced that talk about success using methods of oxygenation. It also highlights that an open mask oxygen system aerates the virus ( which I think was a major consideration for their use .. and very logical to be scared of!) They then discuss what they see in the blood and it being a virus that attacks the red blood cells .. that was the interesting direction.
They also discussed the way medicine is performed, in that it’s process and not diagnosis- the initial NY took a back or more pragmatic view in his second video. He was not dispelling the use of ventilators but to treat each case individually and use the appropriate action not a generic prescribed methodology ( time and human nature falls back to process its a safety net .. so it’s completely understandable that this is happening)

Not saying any of this is right or wrong (Not my area of expertise) just it is interesting and sad that we as a world cannot share and listen to one another ..! and it takes a Dr to release a video because no one is listening.

Good job you warned me about Bigtree's anti-vaccination stance, I might have missed it otherwise. Seriously, I've looked at the 12 minute taster, is there a particular episode you think that's worth a look or is that enough?

I hadn't seen anything about the red blood cells, so apologies for misinterpreting your earlier post about that, I'd somehow missed it. For anyone else who missed it, there's an explanation here;

https://www.jewishpress.com/news/us...-new-treatments-with-old-standbys/2020/04/10/

I think I saw a posted the other day about there potentially being greater danger in the Corona Virus for BME individuals because they naturally produce less Vitamin D. If the issue with the red blood cells is correct, would the prevalence of sickle cell disease in BME individuals not be a greater threat than the Vitamin D issue.

Not my area of expertise either, just trying to understand it a bit more, so thanks for the heads up and apologies for any misunderstandings.

 

[Blue in Munich]

CPAP versus an Intensive Care Ventilator. Where to start?

A Continuous Positive Airway Pressure(CPAP) pumps out a continuous flow of gas. Sometimes they are just a pump that pushes out room air, the sort used to combat sleep apnoea. Sometimes they have piped gas, allowing them to have the oxygen content dialled up - a hospital CPAP.

Why a continuous base pressure in the lungs? COVID sees a build up of (sticky) fluid in the lungs. It acts as a barrier to the oxygen AND it can also act as a glue, sticking the sides of the air sacks together potentially leading to a collapsed lung. Therefore, keep a base pressure in there with a dialled up O2 level and, all things being equal, it sorted.

Should we throw all the high end ventilators in the store cupboard till the end of the crisis? No, no and thrice no! Why not? Simply, for your most ill patients a high end ventilator can be set up as a very VERY sophisticated CPAP. It has levels of pressure support and control that your CPAP device just doesn't have. To use an analogy, what gets you around Silverstone quicker, a Ford Fiesta or a Ferrari? And as frightening as it might sound, you could switch on a CPAP and put a mask on a patient but you need the Lewis Hamilton of nursing to set up an ITU vent. An ITU nurse is just wow! Seriously, they are phenomenal.

If you put a chronically ill COVID patient on a basic CPAP they might still get better but they'll get better quicker on a sophisticated ITU vent set to CPAP.

But why do more patients die on ITU vents than on CPAP's? Because its your basket cases that are put on an ITU vent.

Thanks Brian, the article suggested they were completely different beasts, no intimation that I saw that the regular ventilator was "multi-function" so to speak.

 

[Italian outcast]

Good job you warned me about Bigtree's anti-vaccination stance, I might have missed it otherwise. Seriously, I've looked at the 12 minute taster, is there a particular episode you think that's worth a look or is that enough?

I hadn't seen anything about the red blood cells, so apologies for misinterpreting your earlier post about that, I'd somehow missed it. For anyone else who missed it, there's an explanation here;

https://www.jewishpress.com/news/us...-new-treatments-with-old-standbys/2020/04/10/

I think I saw a posted the other day about there potentially being greater danger in the Corona Virus for BME individuals because they naturally produce less Vitamin D. If the issue with the red blood cells is correct, would the prevalence of sickle cell disease in BME individuals not be a greater threat than the Vitamin D issue.

Not my area of expertise either, just trying to understand it a bit more, so thanks for the heads up and apologies for any misunderstandings.

You make a very good point
Almost certainly having sickle cell disease- or even only sickle cell trait - has to be considered a factor - but I think most people are aware of that - the Vit D story may well be a red herring
Evaluating what and how will be difficult - the US experience will be very informative when available
AS always it will be only after the dust settles that some lessons can begin to be learned

 

[harpo_72]

Good job you warned me about Bigtree's anti-vaccination stance, I might have missed it otherwise. Seriously, I've looked at the 12 minute taster, is there a particular episode you think that's worth a look or is that enough?

I hadn't seen anything about the red blood cells, so apologies for misinterpreting your earlier post about that, I'd somehow missed it. For anyone else who missed it, there's an explanation here;

https://www.jewishpress.com/news/us...-new-treatments-with-old-standbys/2020/04/10/

I think I saw a posted the other day about there potentially being greater danger in the Corona Virus for BME individuals because they naturally produce less Vitamin D. If the issue with the red blood cells is correct, would the prevalence of sickle cell disease in BME individuals not be a greater threat than the Vitamin D issue.

Not my area of expertise either, just trying to understand it a bit more, so thanks for the heads up and apologies for any misunderstandings.

I was trying to post the link but it’s a Facebook special which is 45mins long. He speaks with another Dr who was an AE but now tutors in methods of diagnosis ( I think?) and freely admitted he was not up to date with A&E current practices so was not close to the admittance procedure. But was putting the medical papers into layman’s terms so that plonks like myself could grasp it.
I think you have referenced the Italian Dr’s paper. There were several Chinese papers looking at the same stuff and one paper recorded the success of using a pressure chamber to oxygen saturate the patient.
They also got further into the oxygen delivery methods which Hobbit has detailed.
I think we are all on the same page regards the success of ventilators as they are pretty much last resort “do or die” so it’s too sweeping a statement to say they are responsible or it feels that way IMO .. so forgive me for that if you disagree.

 

[drdel]

Some years ago a family member was put on a ventilator for a lung related issue. I asked the surgeon whether forcing air into the system could in fact force the fluids further and deeper into the lung tissue could be doing the opposite of what was intended. He thought it possible so they Xrayed daily and actually stopped after 24hrs and used the re-oxygenation approach.

 

[harpo_72]

Some years ago a family member was put on a ventilator for a lung related issue. I asked the surgeon whether forcing air into the system could in fact force the fluids further and deeper into the lung tissue could be doing the opposite of what was intended. He thought it possible so they Xrayed daily and actually stopped after 24hrs and used the re-oxygenation approach.

They do keep showing these scans .. it would be interesting to see or put the discussion to bed if they did it on a regular basis to measure the impact

 

[Blue in Munich]

I was trying to post the link but it’s a Facebook special which is 45mins long. He speaks with another Dr who was an AE but now tutors in methods of diagnosis ( I think?) and freely admitted he was not up to date with A&E current practices so was not close to the admittance procedure. But was putting the medical papers into layman’s terms so that plonks like myself could grasp it.
I think you have referenced the Italian Dr’s paper. There were several Chinese papers looking at the same stuff and one paper recorded the success of using a pressure chamber to oxygen saturate the patient.
They also got further into the oxygen delivery methods which Hobbit has detailed.
I think we are all on the same page regards the success of ventilators as they are pretty much last resort “do or die” so it’s too sweeping a statement to say they are responsible or it feels that way IMO .. so forgive me for that if you disagree.

I'm with you , Hobbit & the article insofar as from the stats that we have, it doesn't prove it one way or the other; as you've said, if you're on a ventilator your a fairly long way up creek without a propulsion & steering device, so it's not necessarily a huge surprise that a lot don't make it. It was as much to highlight the fact that the initial diagnosis of the type of disease has moved on, but potentially the treatment might not. I wasn't intending to come across as blaming the ventilators, but in hindsight that was the steer of the article I quoted so I can see how it came across that way. While we are clarifying stuff, it's not intended to criticise the front line medical staff either; they are as much in the dark over what this is as the rest of us, and I have no doubt that they are doing their best in what are truly exceptional circumstances. And I've no problem with polite disagreement, so there's nothing to forgive, all good here.