3 ms·

Yes, this seems to be an extremely morbid disease. The current protocols became widely agreed upon after clinical trials showed that this approach to mechanica

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.
- carbocation 7y ago
  What is the relevance of the pCO2? What is the counterfactual that you or others are proposing? One could use that counterfactual to set up a clinical trial.

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.

carbocation 7y ago
What is the relevance of the pCO2? What is the counterfactual that you or others are proposing? One could use that counterfactual to set up a clinical trial.