Are ventilators causing more harm than good?

[Aqua Letifer]

@George-K So then it's not necessarily the ventilators per se, but either our implementation of them, or our choice to use them, is that correct?

[Mik]

Exactly. We may be overusing them to the detriment of patients that might do better just on O2.

[Mik]

Y'know, I have long thought for a layman I had pretty good medical knowledge, or at least enough to understand with a little research. This has really stretched the limits of my knowledge.

[Loki]

This may explain why the current projection of ventilator needs is only 16,000

There are a couple of new theories about what CV really is but I will not post until they get more concurrence.

[Jolly]

@Mik said in Are ventilators causing more harm than good?:

Y'know, I have long thought for a layman I had pretty good medical knowledge, or at least enough to understand with a little research. This has really stretched the limits of my knowledge.

I find blood gases and all the ins and outs of proper therapy to scramble my brains. Not that it was ever my job. Thank God all I had to do was maintain, control and run the ABG machines.

[mark]

@George-K said in Are ventilators causing more harm than good?:

@Jolly said

Standard at The Lady of The Lake is after they hit 5L, anything past goes to the vent. I don't know what the SaO2 has to be at that point.

Is that a universal standard or disease specific?

I'm quite far out of the ICU loop. The podcast talks about the ARDSNET protocol for intubation. The point is that this more like high-altitude sickness rather than ARDS.

http://www.ardsnet.org/files/ventilator_protocol_2008-07.pdf

For me one of the takeaways on this is that clinical judgment might prevail over protocols and flowcharts. How the patient looks might be just as important as the numbers he presents. Whenever I got called about a situation like this, one of my first questions was "How does the patient look?" These people's numbers are terrible, but they don't look that bad, at least in the early stages.

This is quite interesting. I shared it on FB.

[Jolly]

And on that note, try running an ABG in the eye of a hurricane.

Ain't happening...

[LuFins Dad]

@Loki No, the reason the current projections seem so low is because the new projections are based on data vs early projections based on models of Italy, not the US.

[jon-nyc]

@LuFins-Dad

Not even Italy. Wuhan.

[LuFins Dad]

@jon-nyc even worse.

[A Former User]

This post is deleted!

[kluurs]

A friend who is an ER doc in NYC shared this - story. There are better interventions available - proning and oxygen therapy appear to be more advantageous than immediately putting people on ventilators.

"At Lincoln Hospital in the Bronx, Dr. Nicholas Caputo followed 50 patients who arrived with low oxygen levels between 69 and 85 percent (95 is normal). After five minutes of proning, they had improved to a mean of 94 percent. Over the next 24 hours, nearly three-quarters were able to avoid intubation; 13 needed ventilators. Proning does not seem to work as well in older patients, a number of doctors said."

[Loki]

Per HHS there will be 35,700 additional ventilators in the stockpile by June 1 and 137,431 by the end of 2020. Meanwhile IMHE says a total of 13,851 are needed in total.

Sounds like given what’s out there + the 137k we are in great shape.

[Copper]

Ventilator storage 2021

[George K]

@Loki said in Are ventilators causing more harm than good?:

Per HHS there will be 35,700 additional ventilators in the stockpile by June 1 and 137,431 by the end of 2020. Meanwhile IMHE says a total of 13,851 are needed in total.

Sounds like given what’s out there + the 137k we are in great shape.

I dont remember who said it: “In a year we’going to have a lot of expensive end tables.”