Using vents the "wrong way" or over-using? Maybe not pneumonia doctors are seeing

[emmaverybo]

but something different.

Snip—————————

Across the country, hospital administrators, doctors and public officials are pleading for ventilators, as the spread of coronavirus is making growing numbers of patients dependent on the machines that pump oxygen into their lungs to keep them alive. The subject comes up at almost every White House briefing on coronavirus, and the administration has even proposed an emergency effort to retool automobile factories to make more of the devices.

In New York, the epicenter of the coronavirus outbreak in the U.S., Gov. Andrew Cuomo has largely focused his energy on efforts to bolster the state’s dwindling stockpile of ventilators, while officials in a number of other states have begun developing or updating guidelines for how to ration ventilators in the event of a shortage.

But while hospitals and health care workers grapple with the grim reality that they may soon be forced to deny potentially life-saving treatments to certain patients due to a lack of supplies, some doctors are raising questions about how ventilators are currently being used on coronavirus patients — and whether they may actually be doing more harm than good. Early reporting on coronavirus deaths from China, Italy and the U.S. show that more than half — and as many as two-thirds — of COVID-19 patients who are placed on ventilators don’t survive.

What we’re doing now is not working, and I think making the same mistake over and over is a sign of stupidity,” Dr. Paul Marik told Yahoo News. “If it’s not working, we’ve got to look for something else.”

https://news.yahoo.com/rethinking-coronavirus-some-doctors-question-how-we-use-ventilators-123733204.html

[Cousin Dupree]

1. That is a very interesting article. Looks like treatment for Covid 19 is evolving and may include.

avoidance of ventilators as much as possible. Thank you.

[hedda_foil]

2. His treatment is untested and steroids were not found effective in studies with SARS, MERS.

Marik’s protocol is untested, and his advocacy of vitamin C is very much a minority view. It is absolutely not something people can or should try for themselves; the corticosteroids are administered intravenously. One doctor who has been treating COVID-19 patients at a New York-area hospital says there’s no reason to believe it would work. Marik acknowledged that the World Health Organization has advised against the use of corticosteroids to treat viral pneumonia in patients with COVID-19 (except in clinical trials) citing previous studies on other viral diseases like SARS and MERS, which found insufficient evidence that the drugs were effective.

[emmaverybo]

5. Yes. But that's not the essential info in the article. It is about whether in some cases less vent

pressure or high flow oxygen would be more advisable. And the steroids are used by many doctors
in the case of cytokine storm just as they are used in auto-immune disorders. Jury may be out and they can be misused but many would use them under certain conditions,


China and Italy have noted that the “pneumonia” is very different than usual seen in other viruses.

That really Is what the article is about, not one doctor’s take on treating with steroids. And vite C has never been proven successful, but docs do try it.

PS vite C “cured“ my recurrent serious sinus and upper respiratory condition caused probably by allergy as a little girl. My doctor had studied under Linus Pauling at Stanford U. Some of us are deficient in it.

[octoberlib]

3. This article in statnews was so interesting .

Link to tweet

Every paragraph of this story is fascinating... “suggests the lungs are still accomplishing the critical job of removing carbon dioxide even if they’re struggling to absorb oxygen. That, too, is reminiscent of altitude sickness more than pneumonia.”

[emmaverybo]

6. Wow.

[peggysue2]

4. Thought this was a fascinating development

Number one, it underscores how different Covid-19 is in terms of other diseases/viral infections, and

Number two, because Covid is different in the way it clinically presents, particularly in ICU patients with subsequent breathing/oxygen issues, medical teams are questioning the standard protocols of ventilator use, even the Italian doctor who helped write the protocol used world-wide.

We may find out that Covid-19 will bust the one-size-fits-all paradigm with ventilator use because the vast majority of patients are not exhibiting the common ARDS (Adult Respiratory Distress Syndrome) symptoms. Weirdly, these patients are showing signs more akin to high-altitude sickness, hypoxia. So, it's not a matter of the lungs not physically working (and/or the patient wearies out) where heightened pressure is recommended to 'open' the lungs, it's a problem with oxygen absorption, the way Covid attaches itself to oxygen on a microscopic level and prevents proper saturation. That poor saturation starts with the lungs and cascades throughout the body resulting in organ failure. There's also some discussion of iron ions being released from their normal encapsulation that start free-floating through the body wreaking havoc.

This theory if factual would go a long way in explaining the dismal survival rates of ventilated Covid-19 patients. My son was placed on a ventilator after a serious head injury, a lifesaver. I was astonished to read that the current survival rate with Covid is a mere 20-30%. That's dismal for patients and health providers alike. One of the explanations is the need to keep patients on the vents for longer periods (11-20+ days) which makes weaning off more difficult and increases the likelihood of infection.

That being said, this could be an important breakthrough in understanding Covid-19 as a unique (very novel) virus and improved, more successful treatment decisions.

One thing seems true: this ain't the regular flu!

BTW, I'm not a medical person, so this is just what I gleaned from the recent published info on the subject. The theory is just getting traction. Any doctors on the board are free to correct me on the details.

However, this appears to be good news and we certainly could use some positive reports from the field.

We shall see.

Talking Points Memo has been following this story. There's quite a bit of info and links at the site.

[emmaverybo]

7. Explained the central questions well to this layperson who has problems processing scientific

info and added to the discussion I found. Thanks for pointing to other sources,

[peggysue2]

9. I think it's an important development

Where it leads? Haven't the foggiest. But the young critical care/ER doctor from NYC who has several vids on the topic is in touch with numerous clinicians across the country. They're comparing notes and discussing possible explanations and treatment considerations, a virtual consortium. Then this well-known doctor from Italy comes out with a paper discussing the same observations made with his colleagues during the crisis and begins swapping info with other European physicians with similar observations in the field. The buzz grows louder.

All of this will be discussed, argued, peer-reviewed, of course. But, these doctors may be on to something that could save lives and prevent lung damage. Which is what everyone wants.

Thanks for putting up the OP!

[Igel]

8. What they see is a symptom.

Call it "Fred" if you want to, they see the symptom.

Your blood oxygen level drops. You clear the airway.

It doesn't help? Give them oxygen. Several ways of doing this under the patient's own lung power.

It doesn't help? Odds are that their lungs aren't working right. Use a mechanical ventilator.

It doesn't help? Crank the O2 level to 100%, forcing the pure oxygen into their lungs.

It helps? Let them heal.

If their lungs are too damaged it may not be enough and it won't help, or won't help enough. Then you're stuck with a machine that pulls blood out of your body, oxygenates it, and returns it.

If their lungs aren't too damaged and they heal, the lung tissue may be scarred over. Lung membranes are thin--the oxygen has to dissolve in water and get picked up by the blood stream. If the membranes are too thick, oxygen doesn't cross them well enough. You can still live, but with an oxygen tank by your side. But somebody will have to disconnect you, monitor you, and that takes time.

If the tissue is too stiff then something would have to mechanically inflate your lungs. You can't be disconnected unless you have lung replacement surgery, and nobody's going to be doing those just now.