6 ms·

Interesting points, thank you. I previously mostly had the death rate for "ordinary" ICU admissions in mind, which were 50%. Didn't know that once you are you a

by est31 7y ago

Interesting points, thank you. I previously mostly had the death rate for "ordinary" ICU admissions in mind, which were 50%. Didn't know that once you are you are connected a ventilator, you have a 80% death rate. To compare the effect of ventilators vs none, one needs good studies with randomized groups where one gets ventilators and the other doesn't. But I guess those aren't available and doing them is probably not possible due to moral issues. I wonder if there are statistics that are the next best thing, death rate of people who doctors would have wanted to connect to ventilators but there were none available. You shouldn't compare it to the death rate of people with ventilators in places where there is ventilator shortage because then obviously there is some element of choice in who gets the ventilator and who doesn't, e.g. they choose the patients with the worst symptoms, or the patients with the largest chances of survival. Most places probably have/had shortages, so the data we have are all pretty bad to judge whether ventilators help, and if yes how much.

DoreenMichele 7y ago
I have a really serious lung condition. I used to use mechanical intervention to treat my condition. I have found other methods and no longer do that, in part because such interventions are hard to keep adequately sterile and are known to increase risk of antibiotic resistant infections because of that element. It's really not good to think of this problem space in terms of finding some group without ventilators at all. I get your point about the data, but the problem is that lungs are a critical system. If you have lung issues, you are a priority admit at an ER because that whole not breathing thing can kill within minutes. Inability to breathe is one of the quicker ways to die. What I was previously suggesting was non invasive airway clearance methods and management techniques like being mindful of better positions to sleep in (which is apparently at least part of what some doctors are now doing according to the article I linked above). I got hounded and attacked as "practicing medicine without a license" for talking about my first-hand experience with managing my very deadly condition using such techniques. You really can't just not treat patients experiencing lung distress and hope they live. That's a good way to kill people. But I have looked at a little info on ARDS (the process that actually kills people with Coronavirus) and how ventilators work and I'm quite horrified that the world rushed to create more ventilators rather than rushing to say "We must do everything possible to intervene effectively without ventilators. Ventilators must be an absolute last ditch effort after every other possible intervention has been exhausted." They aren't doing that. They are too quick to put people on ventilators and the fact that doctors are now coming up with non invasive alternatives tells you they haven't been sufficiently aggressive in exhausting all other treatment modalities first. I have substantial first-hand experience with staying alive in the face of having routine lung distress that could kill me. I knew from the outset that they were putting people on ventilators too quickly, that ventilators are quite dangerous in their own right and that there are, in fact, other options available. I'm quite frustrated by the whole thing. This absolutely never needed to be this ugly. I'm certainly not the only person on the planet who knew ahead of time that ventilators are problematic and that there are myriad other options available that can be tried first, especially before it gets that severe in hopes of not letting it get to that point.
- Santosh83 7y ago
  Outcome of reductionist thinking that is plaguing the world, thanks to its great success by and large, but the downside is wholistic approaches have been contemptuously tossed in the trash.
- cycomanic 7y ago
  The thing is generally for lung treatment doctors follow a path of escalation, start with less invasive methods like oxygen and progress to ventilators. With covid 19 there have been several reports from doctors that skipping this and putting the patient directly on ventilators directly significantly improves survival. Doesn't that contradict what you are suggesting.
  - DoreenMichele 7y ago
    Source? I cited my source, above. What you're saying is news to me. Without a source, I can only reply based on general life experience that most doctors are lazy and quick to prescribe drugs and surgery (or similar intervention -- in this case, ventilators) in place of trying to insist on educating patients and taking more low tech, often labor-intensive approaches instead. I have seen all the handouts saying if you have allergies and respiratory problems, your first line of defense should be things like having wood floors at home instead of carpeting. Not once has a doctor ever sat me down and had a meaty discussion with me about my decor choices or similar. It's always been, at best, "Which drug is your favorite?"
    - Kliment 7y ago
      The Chinese recommendations document ( Handbook of COVID-19 Prevention and Treatment available from https://covid-19.alibabacloud.com/ https://covid-19.alibabacloud.com/ ) suggests oxygen early on, and not keeping patients on noninvasive ventilation for long before moving on to invasive, or skipping noninvasive altogether (intubating earlier rather than later) gives better outcomes. I suspect this is what the parent post is referencing. However, this applies to hospitalized patients in intensive care. High flow oxygen is the best way to prevent them from reaching that stage. What you're talking about is a much earlier stage of treatment, in order to prevent the need for hospitalization. Once a patient has reached the invasive ventilation stage their chances of recovery have already dropped massively, but at that stage the outcomes with invasive ventilation are significantly better than without. That said, all the emergency hospitals with capacities in the thousands being built are designed to get as many patients as possible on oxygen early on, as this definitely prevents many deaths. Their ventilator patient capacity is significantly lower - the bulk of them (as used in China, Spain, Italy) are just endless rows of beds and oxygen plumbing, to relieve the ICUs and isolation wards from people who just need oxygen and isolation and allow them to be used to only treat critical patients.

by est31 7y ago

DoreenMichele 7y ago

I have a really serious lung condition. I used to use mechanical intervention to treat my condition. I have found other methods and no longer do that, in part because such interventions are hard to keep adequately sterile and are known to increase risk of antibiotic resistant infections because of that element. It's really not good to think of this problem space in terms of finding some group without ventilators at all. I get your point about the data, but the problem is that lungs are a critical system. If you have lung issues, you are a priority admit at an ER because that whole not breathing thing can kill within minutes. Inability to breathe is one of the quicker ways to die. What I was previously suggesting was non invasive airway clearance methods and management techniques like being mindful of better positions to sleep in (which is apparently at least part of what some doctors are now doing according to the article I linked above). I got hounded and attacked as "practicing medicine without a license" for talking about my first-hand experience with managing my very deadly condition using such techniques. You really can't just not treat patients experiencing lung distress and hope they live. That's a good way to kill people. But I have looked at a little info on ARDS (the process that actually kills people with Coronavirus) and how ventilators work and I'm quite horrified that the world rushed to create more ventilators rather than rushing to say "We must do everything possible to intervene effectively without ventilators. Ventilators must be an absolute last ditch effort after every other possible intervention has been exhausted." They aren't doing that. They are too quick to put people on ventilators and the fact that doctors are now coming up with non invasive alternatives tells you they haven't been sufficiently aggressive in exhausting all other treatment modalities first. I have substantial first-hand experience with staying alive in the face of having routine lung distress that could kill me. I knew from the outset that they were putting people on ventilators too quickly, that ventilators are quite dangerous in their own right and that there are, in fact, other options available. I'm quite frustrated by the whole thing. This absolutely never needed to be this ugly. I'm certainly not the only person on the planet who knew ahead of time that ventilators are problematic and that there are myriad other options available that can be tried first, especially before it gets that severe in hopes of not letting it get to that point.

Santosh83 7y ago
Outcome of reductionist thinking that is plaguing the world, thanks to its great success by and large, but the downside is wholistic approaches have been contemptuously tossed in the trash.
cycomanic 7y ago
The thing is generally for lung treatment doctors follow a path of escalation, start with less invasive methods like oxygen and progress to ventilators. With covid 19 there have been several reports from doctors that skipping this and putting the patient directly on ventilators directly significantly improves survival. Doesn't that contradict what you are suggesting.
- DoreenMichele 7y ago
  Source? I cited my source, above. What you're saying is news to me. Without a source, I can only reply based on general life experience that most doctors are lazy and quick to prescribe drugs and surgery (or similar intervention -- in this case, ventilators) in place of trying to insist on educating patients and taking more low tech, often labor-intensive approaches instead. I have seen all the handouts saying if you have allergies and respiratory problems, your first line of defense should be things like having wood floors at home instead of carpeting. Not once has a doctor ever sat me down and had a meaty discussion with me about my decor choices or similar. It's always been, at best, "Which drug is your favorite?"
  - Kliment 7y ago
    The Chinese recommendations document ( Handbook of COVID-19 Prevention and Treatment available from https://covid-19.alibabacloud.com/ https://covid-19.alibabacloud.com/ ) suggests oxygen early on, and not keeping patients on noninvasive ventilation for long before moving on to invasive, or skipping noninvasive altogether (intubating earlier rather than later) gives better outcomes. I suspect this is what the parent post is referencing. However, this applies to hospitalized patients in intensive care. High flow oxygen is the best way to prevent them from reaching that stage. What you're talking about is a much earlier stage of treatment, in order to prevent the need for hospitalization. Once a patient has reached the invasive ventilation stage their chances of recovery have already dropped massively, but at that stage the outcomes with invasive ventilation are significantly better than without. That said, all the emergency hospitals with capacities in the thousands being built are designed to get as many patients as possible on oxygen early on, as this definitely prevents many deaths. Their ventilator patient capacity is significantly lower - the bulk of them (as used in China, Spain, Italy) are just endless rows of beds and oxygen plumbing, to relieve the ICUs and isolation wards from people who just need oxygen and isolation and allow them to be used to only treat critical patients.