NEW YORK (AP) — As health officials around the world push to get more ventilators to treat coronavirus patients, some doctors are moving away from using the breathing machines when they can.
Sadly this is all ripe for whacko nutjobs to concoct new conspiracy theories.
I think trump will use this to support his failure to distribute enough ventilators. He didn’t want to cause more damage because ventilators aren’t that effective anyway.
“Some doctors are experimenting with adding nitric oxide to the mix, to help improve blood flow and oxygen to the least damaged parts of the lungs.”
Boss Screed is gonna trash nitric oxide as “Horrible!”
(Until he corners the market on nitric oxide.)
It’s a strange article, indeed, that says both this:
some doctors worry that the machines could be harming certain patients.
and this:
“We know that mechanical ventilation is not benign,” said Dr. Eddy Fan, an expert on respiratory treatment
Dr. Fan is right: The possibility of harm is well known and well understood.
I’m not sure what’s news in all of this.
This may help provide some clarity to this article:
“The ventilator is not therapeutic. It’s a supportive measure while we wait for the patient’s body to recover,” said Dr. Roger Alvarez, a lung specialist with the University of Miami Health System in Florida.
From what the anecdotal data has shown, ventilators are the last resort for Covid patients whether they have comorbidity issues or were treated at the later stage of infection.
So in comparison to other illnesses ie cancer, cancer is best treated at an early stage…it seems that is similar for Covid too…early detection so that that the patient is healthier and can recover when treated. Thus it makes more sense to have everyone tested ASAP both for medical reason and economic reason.
So where are the Covid tests for Americans?
Those 70 days of lying, denying, delaying…bragging about TV ratings, FB followers, golfing, playing TV doctor…urgggggh -
Those 70 days that we could NOT get back…If the Trump Regime have done their job, maybe the death toll, currently at 14k+, would not be as high!
The Trump Regime has a lot of blood in their hands in this tragedy!
Well everyone knows that Trump’s uncle John had a doctorate from MIT so he knows the connection between the body and mechanical devises. For gosh sakes C he is a stable genius!
A tidbit to get Trump out of the stockpile screw up.
there is a general population misconception that ventilators are a necessary part of recovering from a covid-19 hospital stay. Instead, they are a last-resort measure from which less than half of patients survive, and even then often with permanent damage.
there may have been excessive early application of ventilators to patients (probably with much urging from that patient’s family), and they’re trying to figure out guidelines for when a ventilator either will not help or is contra-indicated.
That’s always going to be true about this or that – but what I queried is something else, as reflected right up there in the headline:
Some Doctors Fear Ventilators Could Be Harming Certain Patients
It’s that first bit that makes the article strange (to me).
Anyway, thanks – and have a great evening.
Seems TPM staff don’t know much about doctors and their egos.
STOP comparing ARDS to COVID. They are not the same thing at all. ARDS is an inability to breathe hence you don’t get air in. COVID is a lung obstruction. You may be able to breathe but there’s no gas exchange surface to take O2 in because it’s flooded. So you don’t get air in. Ventilators were deigned to breathe for a patient. To fill the lungs with air or O2 and let it out in a rhythm similar to breathing. Hence there importance in treating a disease like Acute Respiratory Distress Syndrome. But they can also drive O2 into a patient with limited alveolar space, like a COVID patient to maximize O2 absorption in what little space is available.
Bottom line: YES Vents were devised to treat ARDS but that does not mean they have no use in treating other pulmonary conditions. Lets stop with that talk.
Then the hypoxia thing. Low blood O2. That’s what kills you in ARDS and that’s what kills you in COVID. Hypoxia is a symptom of both conditions. The treatment for the absence of something is the provision of it. Hypoxic patients need O2. If you can breathe and you are stable you can use passive administration. A mask or a nasal canula. If you can’t breathe you need a vent. If passive O2 administration is not keeping the patient’s O2 at life sustaining levels you need to do something else or that patient dies. I don’t see the confusion in that. The options: a vent driving pure O2 at slightly above normal pulmonary levels is really all you have unless you want to put them on a lung bypass machine. That’s not happening. So you fucking vent the patients.
If you go to a doc in the box and an ER and ask both what their fatality numbers are you might conclude they do a better job in the doc in the box. No. the Box doesn’t get the critical patients an ER gets and that’s why the difference. The reason so many COVID folks on vents die is not due to the vent. It’s because they were the sickest patients and were dying before they were incubated. ALL COVID Patients are treated with mask or canula at the onset. Those that are not destined to become gravely ill will survive on that and never be ventilated. Those that continue to de-compensate under passive conditions will be vented. Of course the sicker patients will have a higher mortality rate. That’s not due to their treatment it’s due to the severity of their affliction.
COVID does not present uniformly. It can be a mild near asymptomatic condition in some people and rapidly fatal one in others with various degrees of severity between the two. Get that. Those with severe disease will get the most intensive treatment and also have a higher mortality rate. Get that.
And lastly…just what the fuck do these “vents are all wrong” doctors suggest we do in lieu of them? Passive O2? That’s ALWAYS done. And how about a few facts on “we suspect the vents may be harming some patients”… Which ones and what was the nature of the harm? If it was pneumo-trauma that was the doctor that setup the machine not the vent or the patient. So what do we do if we ditch the vents and just how are they harming people?
Folks there are many articles by Pulmonologists and CC Docs that excoriate this thinking as grandstanding and fact free. It is nowhere near consensus thinking. It’s really just like HydroxyQ… a stab in the dark because we really do not know what the hell is happening.
There’s that “some” again. OK. If it is harming patients…how? What did it do and what did the doc do or know that allowed him or her to differentiate the death of a patient from COVID related to vent related? How and whom were harmed. Perhaps “some” might tell us.
Mechanism of death from CIVID is low O2 saturation and acidemia. Put a pulse OX on the patient. If sats are low put them on a mask or a canula. If that doesn’t cut it dial up the O2. If that fails ventilate them. As you correctly said: vents are a last resort and last resort is where the death rates are.
It sounds like you know what you’re talking about. But lets also factor in that a certain proportion of the ICU staff have been hauled in from other departments in this all-hands-on-deck situation, and may not have the prior knowlege of ventilators or time to learn. Anyways, I read the (AP, not TPM) article giving it the benefit of the doubt, that the quoted personnel are trying to create headroom for medical staff denying use of ventilators for (possibly) valid reasons, when faced with family members saying “you chose our loved one to die!”.
It’s a bit deeper than that. The hospitals have Senior Staff. Department Heads and section chiefs. Under normal circumstances they are directly involved with patient care and interact with those patients. In the COVID world they become mentors and delegators. They view charts, review cases and instruct less experienced Docs in what to do. That way their expertise is expanded. No hospital is grabbing a hand surgeon and putting them in an ICU without guidance. The hand guy has a basic understanding of the CC environment as well as medicine in general but the Top Doc of the ER or ICU is telling him or her what to do. They aren’t just cut loose to do their thing as best they can.
The word “some” appears in these new interpretations. Who is some? And just what did some see that justifies his or her conclusions. The guy Josh Marshall put on the front page was less than convincing and a bit evasive as well. Some one cited a hospital, yet unnamed, that had a 100% success rate in TX’ing COVID without the use of vents. What hospital was that. I think it’s bullshit.
It’s Medicine. “Just the facts Maam…only the facts”.
Ah, ok, just looked and see what you mean. I tend to check up on the home page about every 3 days, instead reading preferentially the commentable* stuff.
No hospital is grabbing a hand surgeon
My lap band surgeon buddy says he hasn’t been drafted yet.
but the Top Doc of the ER or ICU is telling him or her what to do
Within his/her communication bandwidth limitations, yes. Delegation is good, but suboptimal things happen during the delegees’ gaining of experience.
The word “some” appears in these new interpretations. Who is some?
NYC is ground zero (ugh) in the fight against covid-19, both against the virus and its effects, and against the white house mismanagement of the response. I can understand the necessity for anonymity: even if one is personally invulnerable, bringing the backlash down on the medical institution would be unforgiveable. Now I’m going to take some time and read those front page posts.
*not complaining about not being able to comment directly on editorial or josh posts; if one could every gadfly and fuckwit on this planet would infest those comments
There are two parts of this debate. The utility and the safety of vents in the treatment of COVID. In so far as utility goes all I ask is what else? If vets are out what is in? On the safety aspect I’m not sure what these guys are saying. Is it that COVID renders the lungs unfit for a vent? Or are they saying vents are unsafe in general? Which is bullshit.
I think the difficulty is that the belief is that harm is not caused simply by use of ventilators, but by using them according to protocols not appropriate to this particular infection. Something about increasing oxygen saturation without blowing out the little sac-thingies being the better course.
Some Doctors Fear Ventilators Could Be Harming Certain Patients
Exactly, this proves tRump has been right all along, we don’t need no stinking ventilators… this will have to show up in his daily dump sooner or later.