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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 comp

by 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.
ajross 7y ago
That's a fair point: another angle to the same issue is that not all ventilators are equal. Under normal circumstances a patient gets intubated and goes on the presumptively most reliable machine the hospital has and is cared for by the people who have the most experience managing these cases and devices. When the hospital fills up, you get whatever junk the hospital can get working and are attended by nurses and techs pulled in from other departments. That's a reasonable hypothesis, I think. But yeah, we just don't know. And it may be years before we do. No one has the ability to do a controlled study right now. (Edit: it's absolutely infuriating to see the comment to which I'm replying here grayed out from downvotes. It's a completely reasonable notion phrased as a question, yet HN... doesn't want to hear the answer?)
- DoreenMichele 7y ago
  (Edit: it's absolutely infuriating to see the comment to which I'm replying here grayed out from downvotes. It's a completely reasonable notion phrased as a question, yet HN... doesn't want to hear the answer?) You're right and I've given it a corrective upvote. For a time, I had a PSA in my profile indicating that I think downvotes will be weirder and more hair trigger during a global pandemic. I'm trying to be more thick skinned about weirdness happening in votes on my own comments, but, yes, it's just adding sand in the gears at a time when we don't need more noise.
  - doperroper 7y ago
    and you're about to get shadowbanned by dang-ding. actually, your external IP is (so your whole building or block). there is a small amount of complete losers on here, whonhave zero knowledge in anything, and so the focus in 'being extra nice.' excessive politeness is all they have to contribute, so they make that priority. they downvote and report useful comments from a sme, and it's gone. ding-dang is one of these people, so it flies, at the expense of good content. because here, good=extra-polite, no more. blantly wrong info? keep it, delete the reply saying it's wrong. clearly an ad? keep it, shadowban people bitching it's an ad. I used to post here. then a guy in my 40+ story building, all behind a single IP, kept bitching about nh. I laughed. then they banned him. he made a new account pointing out what I just said. then they blocked the building wan IP. 2000+ people, many I know who read nh. now we know the complainer was correct, and this site turned to a subreddit, modded by an insecure, inept, unskilled loser. and it makes sense. what normal interesting person would want to moderate anything.
dntbnmpls 7y ago
It could also be that too many people not requiring ventilators are put on it. Ventilators are machines that can do significant damage. It's a machine of last resort. There is a reason why 80 to 90% of doctors would refuse ventilators for themselves. https://io9.gizmodo.com/your-doctor-probably-has-a-dnr-heres-why-you-should-co-1702556735 https://io9.gizmodo.com/your-doctor-probably-has-a-dnr-heres... It could simply be an outlier or maybe defective machines or anything really. We don't know and we'll have to wait until the dust settles and we get more data.

by mantap 7y ago

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.

ajross 7y ago

That's a fair point: another angle to the same issue is that not all ventilators are equal. Under normal circumstances a patient gets intubated and goes on the presumptively most reliable machine the hospital has and is cared for by the people who have the most experience managing these cases and devices. When the hospital fills up, you get whatever junk the hospital can get working and are attended by nurses and techs pulled in from other departments. That's a reasonable hypothesis, I think. But yeah, we just don't know. And it may be years before we do. No one has the ability to do a controlled study right now. (Edit: it's absolutely infuriating to see the comment to which I'm replying here grayed out from downvotes. It's a completely reasonable notion phrased as a question, yet HN... doesn't want to hear the answer?)

DoreenMichele 7y ago
(Edit: it's absolutely infuriating to see the comment to which I'm replying here grayed out from downvotes. It's a completely reasonable notion phrased as a question, yet HN... doesn't want to hear the answer?) You're right and I've given it a corrective upvote. For a time, I had a PSA in my profile indicating that I think downvotes will be weirder and more hair trigger during a global pandemic. I'm trying to be more thick skinned about weirdness happening in votes on my own comments, but, yes, it's just adding sand in the gears at a time when we don't need more noise.
- doperroper 7y ago
  and you're about to get shadowbanned by dang-ding. actually, your external IP is (so your whole building or block). there is a small amount of complete losers on here, whonhave zero knowledge in anything, and so the focus in 'being extra nice.' excessive politeness is all they have to contribute, so they make that priority. they downvote and report useful comments from a sme, and it's gone. ding-dang is one of these people, so it flies, at the expense of good content. because here, good=extra-polite, no more. blantly wrong info? keep it, delete the reply saying it's wrong. clearly an ad? keep it, shadowban people bitching it's an ad. I used to post here. then a guy in my 40+ story building, all behind a single IP, kept bitching about nh. I laughed. then they banned him. he made a new account pointing out what I just said. then they blocked the building wan IP. 2000+ people, many I know who read nh. now we know the complainer was correct, and this site turned to a subreddit, modded by an insecure, inept, unskilled loser. and it makes sense. what normal interesting person would want to moderate anything.

dntbnmpls 7y ago

It could also be that too many people not requiring ventilators are put on it. Ventilators are machines that can do significant damage. It's a machine of last resort. There is a reason why 80 to 90% of doctors would refuse ventilators for themselves. https://io9.gizmodo.com/your-doctor-probably-has-a-dnr-heres-why-you-should-co-1702556735 https://io9.gizmodo.com/your-doctor-probably-has-a-dnr-heres... It could simply be an outlier or maybe defective machines or anything really. We don't know and we'll have to wait until the dust settles and we get more data.