12 ms·

Some doctors moving away from ventilators for virus patients

jds375 7y ago
The press release states that doctors have seen that patients on ventilators have higher death rates. But wouldn’t we expect that? If the situation is dire enough to put someone on a ventilator then they’re probably less likely to live anyway? Edit: They do mention that it’s higher than other diseases relatively speaking, but don’t we expect Covid-19 to be higher than say, the flu, given it seems to primarily target the upper respiratory area?
- dehrmann 7y ago
  They're definitely more at-risk, but there's no playbook for covid-19, so doctors have been falling back to what's similar. There hasn't been much science on the effectiveness of ventilators on bad covid-19 cases, just bad survival rates (15-33%) compared to other respiratory issues (50%), so there's reason to question effectiveness of ventilators.
- omgwtfbyobbq 7y ago
  That's expected. I think there's suspicion because the death rate on ventilators is significantly higher than has been seen in the past with acute respiratory distress. https://jamanetwork.com/journals/jama/fullarticle/194560 https://jamanetwork.com/journals/jama/fullarticle/194560 It may be that for some patients going on a ventilator is more dangerous than not because of community acquired infections and/or some other characteristic we don't have a good handle on. This could also just be an unfortunately characteristic of COVID-19, but we should critically examine that assumption in case it isn't.
- DoreenMichele 7y ago
  This is the pertinent detail as to why some doctors are concerned: Generally speaking, 40% to 50% of patients with severe respiratory distress die while on ventilators, experts say. But 80% or more of coronavirus patients placed on the machines in New York City have died, state and city officials say.
  - mantap 7y ago
    Could that not be because of shortages? If there's a shortage of ventilators then only the very sickest patients will get them. Don't see how it's valid to compare numbers against disease in "peacetime".
    - DoreenMichele 7y ago
      I don't know. But another concern is that ventilators are known to cause lung damage (because of the high pressure involved) and are typically only used for a day or two with most conditions. With this, people are being kept on them for a week or two in many cases. So it's not unreasonable to assume that unusually long-term use of a protocol known to harm the lungs is actively creating problems for patients.
      - pbhjpbhj 7y ago
        >ventilators are known to cause lung damage (because of the high pressure involved) // I only know a little from my reading in the last month or so, but ventilators (used with intubated patients) seem very adjustable: you can alter the pressure, the Oxygen percentage, the tidal flow, breathing rate and such. I can see that in order to increase blood Oxygen uptake you might use higher pressures, but surely that's necessary to ensure patients get sufficient oxygen to avoid brain damage or other deleterious effects? Won't the patients suffer in other ways if the Oxygen delivery is lower pressure? When multiple patients share a single ventilator I see there are issues of balancing the supply, but I don't think that's what we're considering here.
        DoreenMichele 7y ago
        Someone linked me to this a few days back: https://www.youtube.com/watch?v=okg7uq_HrhQ https://www.youtube.com/watch?v=okg7uq_HrhQ It explains how they pressurize the lungs to try to keep the alveoli open and why that's very problematic, even when it is only short term. It is so problematic, they sedate people on ventilators so they won't pull the tubing out. It sounds just really gruesome and like a brute force method that can't help but cause serious problems for delicate tissues if you use it for more than a fairly short period of time, which is the norm but is not how it is being used for Coronavirus cases. Oxygen delivery is a complicated thing and I think taking a mechanical approach when mechanics may not be the actual problem is likely misguided.
empath75 7y ago
What I have read is that unlike typical ARDS cases where the lungs are failing, full of fluid and the patient can’t breathe, that Covid 19 patients can often breathe fine, and don’t have a lot of obvious lung damage, but their oxygen levels are dropping to dangerous levels, perhaps because of something that covid 19 is doing to blood vessels in the lungs that prevents oxygen uptake. One doctor likened it to high altitude sickness. What they are suggesting is to put patients on oxygen or low pressure ventilation first.
- jl2718 7y ago
  Can you get me a source on that phenomenon please. I'm working on an unrelated project with the inventor of a drug that can help with this.
  - jacobolus 7y ago
    The doctor who has been most in the news about this in the US is Cameron Kyle-Sidell https://twitter.com/cameronks https://twitter.com/cameronks https://www.youtube.com/channel/UCNgMagm3-NwKdfGiXp8WILg https://www.youtube.com/channel/UCNgMagm3-NwKdfGiXp8WILg https://thinkingcriticalcare.com/2020/03/28/covid-clinical-discussion-w-cameron-kyle-sidell-nyc-ed-icu-doc-in-the-trenches-foamed/ https://thinkingcriticalcare.com/2020/03/28/covid-clinical-d... https://www.medscape.com/viewarticle/928156 https://www.medscape.com/viewarticle/928156 * * * Here’s a preprint from Italian doctors Gattinoni & al. in the journal Intensive Care Medicine https://www.esicm.org/wp-content/uploads/2020/04/684_author-proof.pdf https://www.esicm.org/wp-content/uploads/2020/04/684_author-...
  - DoreenMichele 7y ago
    You might also be interested in this post: https://news.ycombinator.com/item?id=22840057 https://news.ycombinator.com/item?id=22840057
  - ramraj07 7y ago
    Someone posted this above and it's fascinating - https://mailchi.mp/e10a89ac5988/tz4idnzryr-4388986?e=96507de8e5 https://mailchi.mp/e10a89ac5988/tz4idnzryr-4388986?e=96507de...
saurik 7y ago
https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/ https://www.statnews.com/2020/04/08/doctors-say-ventilators-... ^ This article from a few days ago is a more detailed look at what is possibly going on here. From: https://news.ycombinator.com/item?id=22814760 https://news.ycombinator.com/item?id=22814760
op03 7y ago
How does the ventilator not just fill up with the virus over time?
- generatorguy 7y ago
  exhaled air is exhausted to outdoors through filters, fresh air comes in. different tubes for different direction of air flow
  - djsumdog 7y ago
    Right, which is one of the differences between a ventilator and a CPAP machine. CPAPs don't have a return hose, so virus can spread from the exhaled air. Some hospitals are putting breathing masks on people just so they're not spreading virus into the hospital. I've also ready some hospitals are using techniques were O2 levels are increased directly in the blood supply? I can't remember what that's called though.
    - rjsw 7y ago
      > I've also ready some hospitals are using techniques were O2 levels are increased directly in the blood supply? ECMO [1], it has been used quite a bit in Italy too. [1] https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...
- e46dstyy556 7y ago
  Modern ventilators are a bit like an air compressor. Air enters one side, exits the other at higher pressure. There is no place for the virus to accumulate. The contaminated air will just be dumped in the room. There are virus filters (HEPA) which you can attach to the tubing so that the virus is caught there.
carbocation 7y ago
There is a lot of misinformation about COVID-19 lung disease. This article's title is alarming, but most of its content is mainstream. Lung protective ventilation - the standard approach for ARDS (which COVID-19 seems to cause) - avoids high pressure and high volume ventilation. Broadly, I would suggest that interested people read Corey Hardin's response to the cacophony of voices saying that COVID-19 respiratory failure is not ARDS: https://mailchi.mp/e10a89ac5988/tz4idnzryr-4388986?e=96507de8e5 https://mailchi.mp/e10a89ac5988/tz4idnzryr-4388986?e=96507de...
- ramraj07 7y ago
  This article says though that in New York 80% of people put on a ventilator die; is that fact refuted by anyone? For a machine that's in short supply and quite invasive, a 20% survival probability seems extremely low.
  - carbocation 7y ago
    Yes, this seems to be an extremely morbid disease. The current protocols became widely agreed upon after clinical trials showed that this approach to mechanical ventilation reduced mortality. It is in physicians' nature to speculate about new approaches to care for sick patients. But it's important (for MDs) to put that speculation into the proper context and understand equipoise.
    - ramraj07 7y ago
      Okay first of all thank you for that resource. I read through it (not all the references yet but that's next). Clearly written by experts, but something I'll still fully disagree. The mailing list analysis seems far more concerned with trying to determine if this is "ARDS as we define it" or not. It touches on way too many angles and tries to address many random hypothesis (the hemoglobin one is so outrageous to even bother addressing!), That I'm afraid they're losing focus on the fundamental question - should patients with covid-19 be ventilated the moment their pO2 drops below 90? The author has not convinced me (an amateur) that they should be. They don't address the first primary hypothesis properly, which is that perhaps the pCO2 is actually in acceptable ranges in covid patients for some reason. Clearly the mortality for ventilated patients is higher for covid cases than other sources of past, so it's very intriguing they mix and match findings from 2016 with what we observe in covid. This is not to question the authority of the authors, clearly they are experts, but personal experience from working with experts in academia is that they can also be very wrong because they're lost in the details, which is my worry here. We should hope to strive and be great scientists though, so if a doctor or a scientist asks _why_ we should consider that the ARdS is slightly different in covid, they are owed some explanation and some data. Which we should explore together. In the meanwhile though, unless my further reading is going to change my mind, my current working hypothesis is going to be that the ARDS or whatever in covid patients is fundamentally slightly different in some way that means patients should be put on ventilators much later than conventional wisdom would suggest.
sudosteph 7y ago
Do we know if US doctors are making much use of ECMO (machines that put oxygen in blood directly) for COVID patients? I read that the FDA just approved emergency usage a few days ago, but keep seeing it mentioned in reports from China. If ventilators alone aren't effective, maybe ECMO machines are the piece we really need to be ramping up production on.
- robbiep 7y ago
  This isn’t easy - ECMO is in (very) short supply, Australia during swine flu had somewhere around 50 nationally (cf 2000 vents) + you need a cardiothoracic surgeon to put it in + nursing care is even more intense than for ventilator care. You can’t easily scale this and it isn’t without significant downside as well
- glandium 7y ago
  Japan is said to have tons of ECMO machines. I don't know how often they use them because that doesn't appear in the reports from the ministry of health, but it is worth noting that close to TWO months after people deboarded the Diamond Princess, there are STILL EIGHT of them in ICU, and 48 more still hospitalized, some of which were in ICU at some point.
nradov 7y ago
This has been known by the physicians actively treating COVID-19 for several days, and was incorporated into the treatment protocol published by Eastern Virginia Medical School. https://www.evms.edu/covid-19/medical_information_resources/#d.en.140202 https://www.evms.edu/covid-19/medical_information_resources/...
Barrin92 7y ago
I'm not a physician and I know little about this stuff, but I wondered if itisn't possible to build a machine that oxygenates people's blood outside of the lungs, like a dialysis of sorts? It sounds like forcing air down people's already damaged lungs is what's so dangerous here.
- DoreenMichele 7y ago
  It can be done and has been done, but it's got serious challenges: https://www.thrillist.com/health/nation/cystic-fibrosis-woman-survives-without-lungs https://www.thrillist.com/health/nation/cystic-fibrosis-woma...
- pixelcort 7y ago
  ECMO machines can do this https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...
  - pbhjpbhj 7y ago
    Apparently UK has 15 machines that can do this, for a population of 80M.
    - cleatoma 7y ago
      Population of the UK is less than 70M.
      - pbhjpbhj 7y ago
        Latest figures I saw said 67M, which I misremembered as 77M, and rounded. Thanks for the correction.
sunkenvicar 7y ago
This might be a blood disease. Maybe red blood cells are damaged by the virus and can’t carry oxygen. Perhaps blood transfusions will help improve oxygen saturation.
oliwarner 7y ago
Wow. Detail-light posts like this give readers just enough speculation and doubt to make them dangerous to themselves (or their loved ones). If your doctors are telling you you need to high pressure O2 or ventilation, your sats are in the toilet. You simply can't survive without a breathing aid. High pressure vents can exacerbate damaged lung tissue but it's [probably, citation needed] better than just suffocating. And no, ECMO has a pile of its own issues, well beside being almost mythically rare. Listen to your doctors. They're doing their very best.
- dchichkov 7y ago
  Well, yes, but also do check the statistics. If you see something really wrong in the statistics, look at it twice. Medical systems are known to produce weird results. To give an example, opioid epidemic is killing around 45 thousand Americans per year (ref). And this one was created by the medical system (pharma influencing decisions made by doctors). (ref): Nature, Vol 580, 9 April 2020, page 181, graphics.
  - Paul-ish 7y ago
    Someone should check the statistics, but it should be someone trained to do so.
    - dchichkov 7y ago
      Ideally trained, unbiased, aligned with improving public health. Instead of being aligned with protecting their executive compensation, for example.
  - oliwarner 7y ago
    I think that's a pretty harmful comparison in itself. Over-prescription has certainly been a factor, but nothing compared to dirt cheap heroin and illicit fentanyl. I'm not saying that there's not room for manoeuvre here. Positioning and whatever emergent therapies appear will certainly be factored in by doctors (who are desperate for something), but by the time you need ventilation, you are very, very ill. You simply wouldn't survive without it.
TMWNN 7y ago
I've heard it speculated that the thing to do may be to not put people on ventilators, but give them blood transfusions. Where I heard this: https://science.slashdot.org/comments.pl?sid=16122794&cid=59921250 https://science.slashdot.org/comments.pl?sid=16122794&cid=59... https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/ https://www.statnews.com/2020/04/08/doctors-say-ventilators-...
- ImpressiveWebs 7y ago
  I only scanned and did a page search for the word “transf”, but I couldn’t find anything in those articles recommending transfusions.
  - redfern314 7y ago
    The first link mentions transfusions, but it's really just another comment on Slashdot saying that they heard that some doctors are thinking about hemoglobin-based causes. Nothing concrete or sourced.
jv22222 7y ago
I posted the exact same article a few days ago, 6 points in the first 30 mins and then dropped out of site. https://news.ycombinator.com/item?id=22828822 https://news.ycombinator.com/item?id=22828822 Weird.
garyclarke27 7y ago
ECMO machines (like heart lung except the heart) seem to give much better results. Japan used them for Diamond Princess (only 12 deaths from nearly 700 cases and many elderly) I’ve read ECMO only 20% die vs 45% for Ventilators - Problem is the cost $130000 vs $50,000 and hardly any hospitals have them (in the UK).

The press release states that doctors have seen that patients on ventilators have higher death rates. But wouldn’t we expect that? If the situation is dire enough to put someone on a ventilator then they’re probably less likely to live anyway? Edit: They do mention that it’s higher than other diseases relatively speaking, but don’t we expect Covid-19 to be higher than say, the flu, given it seems to primarily target the upper respiratory area?

dehrmann 7y ago
They're definitely more at-risk, but there's no playbook for covid-19, so doctors have been falling back to what's similar. There hasn't been much science on the effectiveness of ventilators on bad covid-19 cases, just bad survival rates (15-33%) compared to other respiratory issues (50%), so there's reason to question effectiveness of ventilators.
omgwtfbyobbq 7y ago
That's expected. I think there's suspicion because the death rate on ventilators is significantly higher than has been seen in the past with acute respiratory distress. https://jamanetwork.com/journals/jama/fullarticle/194560 https://jamanetwork.com/journals/jama/fullarticle/194560 It may be that for some patients going on a ventilator is more dangerous than not because of community acquired infections and/or some other characteristic we don't have a good handle on. This could also just be an unfortunately characteristic of COVID-19, but we should critically examine that assumption in case it isn't.
DoreenMichele 7y ago
This is the pertinent detail as to why some doctors are concerned: Generally speaking, 40% to 50% of patients with severe respiratory distress die while on ventilators, experts say. But 80% or more of coronavirus patients placed on the machines in New York City have died, state and city officials say.
- mantap 7y ago
  Could that not be because of shortages? If there's a shortage of ventilators then only the very sickest patients will get them. Don't see how it's valid to compare numbers against disease in "peacetime".
  - DoreenMichele 7y ago
    I don't know. But another concern is that ventilators are known to cause lung damage (because of the high pressure involved) and are typically only used for a day or two with most conditions. With this, people are being kept on them for a week or two in many cases. So it's not unreasonable to assume that unusually long-term use of a protocol known to harm the lungs is actively creating problems for patients.
    - pbhjpbhj 7y ago
      >ventilators are known to cause lung damage (because of the high pressure involved) // I only know a little from my reading in the last month or so, but ventilators (used with intubated patients) seem very adjustable: you can alter the pressure, the Oxygen percentage, the tidal flow, breathing rate and such. I can see that in order to increase blood Oxygen uptake you might use higher pressures, but surely that's necessary to ensure patients get sufficient oxygen to avoid brain damage or other deleterious effects? Won't the patients suffer in other ways if the Oxygen delivery is lower pressure? When multiple patients share a single ventilator I see there are issues of balancing the supply, but I don't think that's what we're considering here.
      - DoreenMichele 7y ago
        Someone linked me to this a few days back: https://www.youtube.com/watch?v=okg7uq_HrhQ https://www.youtube.com/watch?v=okg7uq_HrhQ It explains how they pressurize the lungs to try to keep the alveoli open and why that's very problematic, even when it is only short term. It is so problematic, they sedate people on ventilators so they won't pull the tubing out. It sounds just really gruesome and like a brute force method that can't help but cause serious problems for delicate tissues if you use it for more than a fairly short period of time, which is the norm but is not how it is being used for Coronavirus cases. Oxygen delivery is a complicated thing and I think taking a mechanical approach when mechanics may not be the actual problem is likely misguided.

empath75 7y ago

What I have read is that unlike typical ARDS cases where the lungs are failing, full of fluid and the patient can’t breathe, that Covid 19 patients can often breathe fine, and don’t have a lot of obvious lung damage, but their oxygen levels are dropping to dangerous levels, perhaps because of something that covid 19 is doing to blood vessels in the lungs that prevents oxygen uptake. One doctor likened it to high altitude sickness. What they are suggesting is to put patients on oxygen or low pressure ventilation first.

jl2718 7y ago
Can you get me a source on that phenomenon please. I'm working on an unrelated project with the inventor of a drug that can help with this.
- jacobolus 7y ago
  The doctor who has been most in the news about this in the US is Cameron Kyle-Sidell https://twitter.com/cameronks https://twitter.com/cameronks https://www.youtube.com/channel/UCNgMagm3-NwKdfGiXp8WILg https://www.youtube.com/channel/UCNgMagm3-NwKdfGiXp8WILg https://thinkingcriticalcare.com/2020/03/28/covid-clinical-discussion-w-cameron-kyle-sidell-nyc-ed-icu-doc-in-the-trenches-foamed/ https://thinkingcriticalcare.com/2020/03/28/covid-clinical-d... https://www.medscape.com/viewarticle/928156 https://www.medscape.com/viewarticle/928156 * * * Here’s a preprint from Italian doctors Gattinoni & al. in the journal Intensive Care Medicine https://www.esicm.org/wp-content/uploads/2020/04/684_author-proof.pdf https://www.esicm.org/wp-content/uploads/2020/04/684_author-...
- DoreenMichele 7y ago
  You might also be interested in this post: https://news.ycombinator.com/item?id=22840057 https://news.ycombinator.com/item?id=22840057
- ramraj07 7y ago
  Someone posted this above and it's fascinating - https://mailchi.mp/e10a89ac5988/tz4idnzryr-4388986?e=96507de8e5 https://mailchi.mp/e10a89ac5988/tz4idnzryr-4388986?e=96507de...

saurik 7y ago

https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/ https://www.statnews.com/2020/04/08/doctors-say-ventilators-... ^ This article from a few days ago is a more detailed look at what is possibly going on here. From: https://news.ycombinator.com/item?id=22814760 https://news.ycombinator.com/item?id=22814760

op03 7y ago

How does the ventilator not just fill up with the virus over time?

generatorguy 7y ago
exhaled air is exhausted to outdoors through filters, fresh air comes in. different tubes for different direction of air flow
- djsumdog 7y ago
  Right, which is one of the differences between a ventilator and a CPAP machine. CPAPs don't have a return hose, so virus can spread from the exhaled air. Some hospitals are putting breathing masks on people just so they're not spreading virus into the hospital. I've also ready some hospitals are using techniques were O2 levels are increased directly in the blood supply? I can't remember what that's called though.
  - rjsw 7y ago
    > I've also ready some hospitals are using techniques were O2 levels are increased directly in the blood supply? ECMO [1], it has been used quite a bit in Italy too. [1] https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...
e46dstyy556 7y ago
Modern ventilators are a bit like an air compressor. Air enters one side, exits the other at higher pressure. There is no place for the virus to accumulate. The contaminated air will just be dumped in the room. There are virus filters (HEPA) which you can attach to the tubing so that the virus is caught there.

carbocation 7y ago

There is a lot of misinformation about COVID-19 lung disease. This article's title is alarming, but most of its content is mainstream. Lung protective ventilation - the standard approach for ARDS (which COVID-19 seems to cause) - avoids high pressure and high volume ventilation. Broadly, I would suggest that interested people read Corey Hardin's response to the cacophony of voices saying that COVID-19 respiratory failure is not ARDS: https://mailchi.mp/e10a89ac5988/tz4idnzryr-4388986?e=96507de8e5 https://mailchi.mp/e10a89ac5988/tz4idnzryr-4388986?e=96507de...

ramraj07 7y ago
This article says though that in New York 80% of people put on a ventilator die; is that fact refuted by anyone? For a machine that's in short supply and quite invasive, a 20% survival probability seems extremely low.
- carbocation 7y ago
  Yes, this seems to be an extremely morbid disease. The current protocols became widely agreed upon after clinical trials showed that this approach to mechanical ventilation reduced mortality. It is in physicians' nature to speculate about new approaches to care for sick patients. But it's important (for MDs) to put that speculation into the proper context and understand equipoise.
  - ramraj07 7y ago
    Okay first of all thank you for that resource. I read through it (not all the references yet but that's next). Clearly written by experts, but something I'll still fully disagree. The mailing list analysis seems far more concerned with trying to determine if this is "ARDS as we define it" or not. It touches on way too many angles and tries to address many random hypothesis (the hemoglobin one is so outrageous to even bother addressing!), That I'm afraid they're losing focus on the fundamental question - should patients with covid-19 be ventilated the moment their pO2 drops below 90? The author has not convinced me (an amateur) that they should be. They don't address the first primary hypothesis properly, which is that perhaps the pCO2 is actually in acceptable ranges in covid patients for some reason. Clearly the mortality for ventilated patients is higher for covid cases than other sources of past, so it's very intriguing they mix and match findings from 2016 with what we observe in covid. This is not to question the authority of the authors, clearly they are experts, but personal experience from working with experts in academia is that they can also be very wrong because they're lost in the details, which is my worry here. We should hope to strive and be great scientists though, so if a doctor or a scientist asks _why_ we should consider that the ARdS is slightly different in covid, they are owed some explanation and some data. Which we should explore together. In the meanwhile though, unless my further reading is going to change my mind, my current working hypothesis is going to be that the ARDS or whatever in covid patients is fundamentally slightly different in some way that means patients should be put on ventilators much later than conventional wisdom would suggest.

sudosteph 7y ago

Do we know if US doctors are making much use of ECMO (machines that put oxygen in blood directly) for COVID patients? I read that the FDA just approved emergency usage a few days ago, but keep seeing it mentioned in reports from China. If ventilators alone aren't effective, maybe ECMO machines are the piece we really need to be ramping up production on.

robbiep 7y ago
This isn’t easy - ECMO is in (very) short supply, Australia during swine flu had somewhere around 50 nationally (cf 2000 vents) + you need a cardiothoracic surgeon to put it in + nursing care is even more intense than for ventilator care. You can’t easily scale this and it isn’t without significant downside as well
glandium 7y ago
Japan is said to have tons of ECMO machines. I don't know how often they use them because that doesn't appear in the reports from the ministry of health, but it is worth noting that close to TWO months after people deboarded the Diamond Princess, there are STILL EIGHT of them in ICU, and 48 more still hospitalized, some of which were in ICU at some point.

nradov 7y ago

This has been known by the physicians actively treating COVID-19 for several days, and was incorporated into the treatment protocol published by Eastern Virginia Medical School. https://www.evms.edu/covid-19/medical_information_resources/#d.en.140202 https://www.evms.edu/covid-19/medical_information_resources/...

Barrin92 7y ago

I'm not a physician and I know little about this stuff, but I wondered if itisn't possible to build a machine that oxygenates people's blood outside of the lungs, like a dialysis of sorts? It sounds like forcing air down people's already damaged lungs is what's so dangerous here.

DoreenMichele 7y ago
It can be done and has been done, but it's got serious challenges: https://www.thrillist.com/health/nation/cystic-fibrosis-woman-survives-without-lungs https://www.thrillist.com/health/nation/cystic-fibrosis-woma...
pixelcort 7y ago
ECMO machines can do this https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...
- pbhjpbhj 7y ago
  Apparently UK has 15 machines that can do this, for a population of 80M.
  - cleatoma 7y ago
    Population of the UK is less than 70M.
    - pbhjpbhj 7y ago
      Latest figures I saw said 67M, which I misremembered as 77M, and rounded. Thanks for the correction.

sunkenvicar 7y ago

This might be a blood disease. Maybe red blood cells are damaged by the virus and can’t carry oxygen. Perhaps blood transfusions will help improve oxygen saturation.

oliwarner 7y ago

Wow. Detail-light posts like this give readers just enough speculation and doubt to make them dangerous to themselves (or their loved ones). If your doctors are telling you you need to high pressure O2 or ventilation, your sats are in the toilet. You simply can't survive without a breathing aid. High pressure vents can exacerbate damaged lung tissue but it's [probably, citation needed] better than just suffocating. And no, ECMO has a pile of its own issues, well beside being almost mythically rare. Listen to your doctors. They're doing their very best.

dchichkov 7y ago
Well, yes, but also do check the statistics. If you see something really wrong in the statistics, look at it twice. Medical systems are known to produce weird results. To give an example, opioid epidemic is killing around 45 thousand Americans per year (ref). And this one was created by the medical system (pharma influencing decisions made by doctors). (ref): Nature, Vol 580, 9 April 2020, page 181, graphics.
- Paul-ish 7y ago
  Someone should check the statistics, but it should be someone trained to do so.
  - dchichkov 7y ago
    Ideally trained, unbiased, aligned with improving public health. Instead of being aligned with protecting their executive compensation, for example.
- oliwarner 7y ago
  I think that's a pretty harmful comparison in itself. Over-prescription has certainly been a factor, but nothing compared to dirt cheap heroin and illicit fentanyl. I'm not saying that there's not room for manoeuvre here. Positioning and whatever emergent therapies appear will certainly be factored in by doctors (who are desperate for something), but by the time you need ventilation, you are very, very ill. You simply wouldn't survive without it.

TMWNN 7y ago

I've heard it speculated that the thing to do may be to not put people on ventilators, but give them blood transfusions. Where I heard this: https://science.slashdot.org/comments.pl?sid=16122794&cid=59921250 https://science.slashdot.org/comments.pl?sid=16122794&cid=59... https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/ https://www.statnews.com/2020/04/08/doctors-say-ventilators-...

ImpressiveWebs 7y ago
I only scanned and did a page search for the word “transf”, but I couldn’t find anything in those articles recommending transfusions.
- redfern314 7y ago
  The first link mentions transfusions, but it's really just another comment on Slashdot saying that they heard that some doctors are thinking about hemoglobin-based causes. Nothing concrete or sourced.

jv22222 7y ago

I posted the exact same article a few days ago, 6 points in the first 30 mins and then dropped out of site. https://news.ycombinator.com/item?id=22828822 https://news.ycombinator.com/item?id=22828822 Weird.

garyclarke27 7y ago

ECMO machines (like heart lung except the heart) seem to give much better results. Japan used them for Diamond Princess (only 12 deaths from nearly 700 cases and many elderly) I’ve read ECMO only 20% die vs 45% for Ventilators - Problem is the cost $130000 vs $50,000 and hardly any hospitals have them (in the UK).