New thinking about ventilators and Covid 19

[Jingthing]

This is potentially big news.

 

https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/?utm_source=digg

 

Quote

With ventilators running out, doctors say the machines are overused for Covid-19

We've all heard about ventilator shortages or concerns about ventilator shortage at hospitals all over the world.

But consider that once a Covid patient goes south to the point of needing one of those precious ventilators, their odds of surviving become unlikely (the longer on it the more unlikely) and even if they survive there will often be permanent damage.

 

I won't get too deep into the content here but here's my short take on the included article --

 

Covid is really a novel disease.

Doctors are treating patients based on their knowledge of respiratory diseases they know,  but that same correct treatment for those diseases could be damaging or fatal for Covid.

Specifically the blood oxygen level readings that indicate a need for a ventilator in the case of Covid might not actually need a ventilator. 

When using a ventilator, doctors may be putting too much air pressure (resulting in damage or death) for the treatment of the effects of this disease.

Quite often less extreme breathing assistance may be life saving for Covid patients rather than the ventilator.

Some patients will still need the ventilators.

 

Well, read the article. 

If it's true and doctors learn about this, it could save a lot of lives and certainly address the ventilator shortage anyway.

 

A concern I would have in Thailand (or really anywhere) is if this new information is true, it's kind of the luck of the draw whether the specific hospital and doctors a patient is treated by would even know to at least consider this new information. 

 

Since it's so new, would Thai doctors be aware of these new concerns?

 

Certainly some U.S. doctors have a lot more experience with Covid than Thai doctors. For Thailand's sake lets hope it stays that way, but no guarantees.

 

Any doctors here feel welcome to comment.

 

I don't have the background to really judge the significance of this news. but it does seem that it MIGHT be significant. 

 

Edited April 8, 2020 by Jingthing

[CG1 Blue]

Interesting. That's the scary thing about a new virus - there is always going to be a degree of trial and error. This part is especially spooky:

 

"What’s driving this reassessment is a baffling observation about Covid-19: Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen."

 

It's almost like Covid 19 is tricking medics into taking the wrong course of action. 

[Jingthing]

2 minutes ago, CG1 Blue said:

Interesting. That's the scary thing about a new virus - there is always going to be a degree of trial and error. This part is especially spooky:

 

"What’s driving this reassessment is a baffling observation about Covid-19: Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen."

 

It's almost like Covid 19 is tricking medics into taking the wrong course of action. 

I agree. That definitely sounds remarkable. Viruses are only doing their thing and it's silly to anthropomorphize them but sorry, this is one EVIL virus.

[donnacha]

The role of doctor is far more procedural in Thailand. That is very good for well-established treatments that require less out-of-the-box thinking.

Culturally, there is less inclination towards innovation. There is a greater fear of being seen to fail. Playing it save and doing what everyone else is doing is a successful strategy in Thailand. We see this in other professions too, not least anything involving bureaucracy.

In general, doctors in Thailand are also less comfortable with explaining what they are doing or answering questions. They are certainly not happy bunnies if they perceive that their authority is being challenged. Where a Western doctor might actually be interested if a patient drew their attention to some new research or approach to their illness, a Thai doctor is more likely to perceived an implicit criticism that he did not already know about it.

So, sadly, I would guess that most Thai doctors would be both less likely to be aware of these findings, and less likely to react positively to being told about them.
 

Edited April 8, 2020 by donnacha

[scubascuba3]

There are a couple of oxygen stages prior to the ventilator, there's the tube down the throat, then there seems to be the face mask. 

 

They could test the theory easy enough, 2 people in similar conditions, one goes on the ventilator and the other keeps using just oxygen

[Why Me]

56 minutes ago, scubascuba3 said:

They could test the theory easy enough, 2 people in similar conditions, one goes on the ventilator and the other keeps using just oxygen

And whoever dies first don't use that method. I find your ideas intriguing and wish to subscribe to your newsletter.

[Roy Baht]

Yeah, apparently only 20% of patients survive after being put on a ventilator. If you reach the point where you're put on one, you're pretty much already a goner.

[scubascuba3]

2 hours ago, Why Me said:

And whoever dies first don't use that method. I find your ideas intriguing and wish to subscribe to your newsletter.

I'm sure even you could work out they would pick a trial size

[DrTuner]

Depends on the patient of course. Some seem to be able to tolerate lower oxy levels for some strange reason. If I was evil I'd say their brains don't operate at a level where much oxygen is needed. A study into the methods of the free divers would be interesting.

 

One interesting thing is proning: https://emcrit.org/pulmcrit/proning-nonintubated/ . It's very simple, place the patient so that the <deleted> flows out of the lungs thanks to gravity. From what I've seen most are sitting upright on the beds, exactly the wrong way. Strange that proning is not used more widely.

Edited April 9, 2020 by DrTuner

[DrTuner]

There's something about the oxygenation and red cells ... here's a clinical trial for one treatment that seems related https://clinicaltrials.gov/ct2/show/NCT04326920

 

My gut feeling tells there's more to this.

[dananderson]

19 hours ago, CG1 Blue said:

Interesting. That's the scary thing about a new virus - there is always going to be a degree of trial and error. This part is especially spooky:

 

"What’s driving this reassessment is a baffling observation about Covid-19: Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen."

 

It's almost like Covid 19 is tricking medics into taking the wrong course of action. 

This virus thrives in oxygen rich environments be they airborne or cellular is how I read this.   Ventilators are self contained units however and CPAP/high flow are not.                    "One problem, though, is that CPAP and other positive-pressure machines pose a risk to health care workers, he said.  The devices push aerosolized virus particles into the air, where anyone entering the patient’s room can inhale them. The intubation required for mechanical ventilators can also aerosolize virus particles, but the machine is a contained system after that. "                                                                    

[thaibeachlovers]

On 4/9/2020 at 6:51 AM, Jingthing said:

but sorry, this is one EVIL virus.

Erm, viruses are not evil. They don't have free will and just do what viruses do. Only human's with choice can, IMO, be "evil".

Cars probably kill as many people as viruses, so are cars "evil"?

[thaibeachlovers]

12 hours ago, DrTuner said:

It's very simple, place the patient so that the <deleted> flows out of the lungs thanks to gravity. From what I've seen most are sitting upright on the beds, exactly the wrong way. Strange that proning is not used more widely.

I'm not going to read the link ( not going to take the chance of a computer VIRUS being introduced to my computer ), but does it involve tilting the patient head down? On the ortho ward I worked on we often had patients legs up with traction, but they were never head down as well, which would be pretty hard to tolerate for an extended period of time.

As I see it, viruses bind to body cells; they don't float around in the lungs, which are not large empty spaces, so how would it work anyway?

[thaibeachlovers]

20 hours ago, Why Me said:

And whoever dies first don't use that method. I find your ideas intriguing and wish to subscribe to your newsletter.

How do you think any new medical innovation is trialed? It's often by putting patients with similar problems in different treatments to see which ones work. Sometimes they just give a placebo which doesn't do anything at all.

[DogNo1]

I have seen some new programs showing COVID-19 patients being treated lying face-down.  I have also read that COVID-19 causes residual lung damage whether a ventilator or oxygen is used or not.

 

Personally, I think that physical distancing should be used until the infection rate goes down and then CONTINUE TO BE USED until adequate testing regimens have been developed to determine 1. whether the person is contagious and should be isolated and 2. whether the person has recovered from the virus and can go back into circulation and back to work.

 

As I write this I am watching a resurgence of COVID-19 cases in some countries.  Apparently people went back into circulation too soon.  Boris Johnson is out of ICU ✌️

[Jingthing]

The plot thickens with this ventilator issue. What a time to be an ICU doctor!

 

https://www.washingtonpost.com/outlook/2020/04/10/ventilators-icu-safety-bundle/

 

Quote

 

ICU doctors already know how to get covid-19 patients off ventilators faster

Sticking to safety protocols developed over the past 20 years would help — even in a crisis.

 

 

[thaibeachlovers]

On 4/10/2020 at 8:43 AM, DogNo1 said:

I have seen some new programs showing COVID-19 patients being treated lying face-down.  I have also read that COVID-19 causes residual lung damage whether a ventilator or oxygen is used or not.

 

Personally, I think that physical distancing should be used until the infection rate goes down and then CONTINUE TO BE USED until adequate testing regimens have been developed to determine 1. whether the person is contagious and should be isolated and 2. whether the person has recovered from the virus and can go back into circulation and back to work.

 

As I write this I am watching a resurgence of COVID-19 cases in some countries.  Apparently people went back into circulation too soon.  Boris Johnson is out of ICU ✌️

Don't know about others but unless I was sedated I couldn't lie face down for more than a few minutes. I can't even lie on my back for long.