About ventilators
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I think I posted earlier about the poor prognosis should you require a ventilator if you develop COVID-19.
There's a lot of talk about the need for ventilators in the hardest-hit states.
The American Society of Anesthesiologists states that there are 75,000 ventilators in operating rooms and surgicenters around the country.
Knowing just a bit about OR ventilators, I can say that these are nowhere as sophisticated as ICU ventilators (they basically have only 2 modes - actually only one), but they would be better than nothing.
Considering that these are, for the most part, going unused, because of cancellations of elective surgery, would it not make sense to mobilize these machines? When I started training, a mechanical ventilator was a luxury, to be used on the sickest patients and the most complicated operations. I would sit there, and squeeze the bag, because my resident colleague in the next OR needed the one ventilator we shared among 5 operating rooms.
And, in my opinion, safer than using one ICU machine on two patients.
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Is that what Cuomo meant by âanesthesia ventilatorsâ in his backup plans? Or maybe the item above it?
@jon-nyc I think he meant both.
Every surgicenter I've been to has 3-4 ventilators.
As I said, they're not nearly as sophisticated as an ICU ventilator, but, in a pinch, they'd probably work well enough for those patients who don't need sophisticated controls.
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"This disease has challenged everything that we believed was right six weeks ago."
Link to video -
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"This disease has challenged everything that we believed was right six weeks ago."
Link to video@George-K said in About ventilators:
More....
"This disease has challenged everything that we believed was right six weeks ago."
https://www.youtube.com/watch?
time_continue=53&v=bp5RMutCNoI&feature=emb_logoFascinating. If I were a patient I would ask for the 20-30% that survive the ventilator what does life look like in one year. That would help me in my risk analysis.
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I know a 72 year old guy with diabetes and heart disease that has been on the vent for 4 weeks last Wednesday. The Lake started trying to wean him today. I'm not sure how they do that with a trach, but if they are successful in the next few days, off to rehab he goes.
Color me amazed.
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@George-K said in About ventilators:
More....
"This disease has challenged everything that we believed was right six weeks ago."
https://www.youtube.com/watch?
time_continue=53&v=bp5RMutCNoI&feature=emb_logoFascinating. If I were a patient I would ask for the 20-30% that survive the ventilator what does life look like in one year. That would help me in my risk analysis.
@Loki said in About ventilators:
@George-K said in About ventilators:
More....
"This disease has challenged everything that we believed was right six weeks ago."
https://www.youtube.com/watch?
time_continue=53&v=bp5RMutCNoI&feature=emb_logoFascinating. If I were a patient I would ask for the 20-30% that survive the ventilator what does life look like in one year. That would help me in my risk analysis.
Nobody knows yet.
"You never know what worse luck your bad luck has saved you from."
-Cormac McCarthy -
The thing that I really like about this, and by "like" I mean stuff that fascinates me, is that it's making docs rethink the cast-in-stone algorithms that dictate how any disease should be treated.
When the disease refuses to cooperate, some people have to think out of the box.
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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@Loki said in About ventilators:
@George-K said in About ventilators:
More....
"This disease has challenged everything that we believed was right six weeks ago."
https://www.youtube.com/watch?
time_continue=53&v=bp5RMutCNoI&feature=emb_logoFascinating. If I were a patient I would ask for the 20-30% that survive the ventilator what does life look like in one year. That would help me in my risk analysis.
Nobody knows yet.
@jon-nyc said in About ventilators:
@Loki said in About ventilators:
@George-K said in About ventilators:
More....
"This disease has challenged everything that we believed was right six weeks ago."
https://www.youtube.com/watch?
time_continue=53&v=bp5RMutCNoI&feature=emb_logoFascinating. If I were a patient I would ask for the 20-30% that survive the ventilator what does life look like in one year. That would help me in my risk analysis.
Nobody knows yet.
No, and if it looks like life, it looks better than the alternative so far.
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The thing that I really like about this, and by "like" I mean stuff that fascinates me, is that it's making docs rethink the cast-in-stone algorithms that dictate how any disease should be treated.
When the disease refuses to cooperate, some people have to think out of the box.
@George-K said in About ventilators:
The thing that I really like about this, and by "like" I mean stuff that fascinates me, is that it's making docs rethink the cast-in-stone algorithms that dictate how any disease should be treated.
When the disease refuses to cooperate, some people have to think out of the box.
Well, that's the thing. It looks like they misdiagnosed early cases as ARDS.
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Hey George,
What's the difference between ventilators, in layman's terms.I thought a ventilator basically pumped air in and out. Simple.
Why would an ICU ventilator be so much better. What does being on a ventilator for a period of time have to do with how someone feels/breathes a year later?
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Hey George,
What's the difference between ventilators, in layman's terms.I thought a ventilator basically pumped air in and out. Simple.
Why would an ICU ventilator be so much better. What does being on a ventilator for a period of time have to do with how someone feels/breathes a year later?
@Rainman said in About ventilators:
Hey George,
What's the difference between ventilators, in layman's terms.I thought a ventilator basically pumped air in and out. Simple.
Why would an ICU ventilator be so much better. What does being on a ventilator for a period of time have to do with how someone feels/breathes a year later?
I wish it were that simple.
The simplest thing to adjust is the FiO2 - the amount of oxygen you're giving. Room air is 21%, ventilators go up to 100%.
Then, you have to consider things like, how fast are you going to deliver it? If too fast, with too much pressure, you can pop a lung.
What pattern? How much time devoted to inspiration vs exhalation?
Should you add PEEP (should you let airway pressure drop to zero at the end of a breath?)? If so, how much pressure should remain?
Should you let the patient breathe around the machine, or should you just force the air in, even if the patient is breathing out?
That's just scratching the surface.
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@jon-nyc said in About ventilators:
@Loki said in About ventilators:
@George-K said in About ventilators:
More....
"This disease has challenged everything that we believed was right six weeks ago."
https://www.youtube.com/watch?
time_continue=53&v=bp5RMutCNoI&feature=emb_logoFascinating. If I were a patient I would ask for the 20-30% that survive the ventilator what does life look like in one year. That would help me in my risk analysis.
Nobody knows yet.
No, and if it looks like life, it looks better than the alternative so far.
@Mik said in About ventilators:
@jon-nyc said in About ventilators:
@Loki said in About ventilators:
@George-K said in About ventilators:
More....
"This disease has challenged everything that we believed was right six weeks ago."
https://www.youtube.com/watch?
time_continue=53&v=bp5RMutCNoI&feature=emb_logoFascinating. If I were a patient I would ask for the 20-30% that survive the ventilator what does life look like in one year. That would help me in my risk analysis.
Nobody knows yet.
No, and if it looks like life, it looks better than the alternative so far.
My advance directives will be much more nuanced than that and will prevent my kids from keeping me alive in a state that I do not wish for.
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Hey George,
What's the difference between ventilators, in layman's terms.I thought a ventilator basically pumped air in and out. Simple.
Why would an ICU ventilator be so much better. What does being on a ventilator for a period of time have to do with how someone feels/breathes a year later?
@Rainman said in About ventilators:
Hey George,
What's the difference between ventilators, in layman's terms.I thought a ventilator basically pumped air in and out. Simple.
Why would an ICU ventilator be so much better. What does being on a ventilator for a period of time have to do with how someone feels/breathes a year later?
As I said two years ago, ICU-type ventilators are a whole 'nother thing. Far more sophisticated, and much better at "customization."
Background: The surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice.
Methods: We designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group.
Results: Complete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p = 0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75-9.33, p = 0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns.
Conclusions: Our results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic.
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We made mistakes. That is Medicine when it gets blindsided by the unknown. We treat, we learn, we change tactics and create treatment regimens.
Not to go all Hannity on the thread, but why haven't we seen more intensive intervention at symptom onset with COVID? Why have we not emphasized monoclonal antibody treatment more and we haven't we helped fund the next generation of antibody treatments for emerging variants? Why don't we already have a booster vaccine for the newer variants, especially for the over-65 set of folks?
Why aren't we taking a more intense look at Long Covid symptoms and cures? Why aren't we doing some major follow-ups on long-term adverse effects of the COVID vaccine in certain age groups?
We still have a lot to learn.
