Ventilators causing more harm than good.

I'm a trained nurse so have a very informed view. Most people who have had a general anaesthetic will have been on a ventilator for a short period, maybe hours. So no, ventilators arent designed specifically for comatose patients. Originally ventilators were for surgical procedures. Most ventilators are used for those who are too weak to breathe without assistance, for many reasons. There are several types of ventilation, from positive airway pressure (CPAP) laryngeal mask to full intubation (basically a tube into the windpipe)

OK if you need a ventilator it is because you cannot breathe on your own. This is due to COVID causing pneumonia. . If it is at that stage you are well on the way to being rubber ducked. Its not the ventilator its the disease that causes the problem.

It is very simplistic to say that the lungs are bags of fluids in pneumonia as it is not that accurate, there is fluid in the lungs, but the important thing is that oxygen cannot get to the sacs in the lungs unless you have respiratory pressure. If you cannot breathe on your own then death is 100%. Pushing oxygen into the lungs gives a chance.

That said I am a little surprised that the focus is on ventilators. Certainly we are going to need them, but there are a spectrum of people who are going to need support of some kind, but less than ventilation. The most fortunate are those who have the odd sniffle. The next lot are going to feel awful, with fever and coughing, far worse than any flu. Then those who are suffering respiratory problems but can breathe unaided. This is the category (which I fall into) where things like typical asthma inhalers could be useful, but the press does not focus on this. A steroid inhaler could be immensely useful here. You know, the brown one? The blue one, salbutamol is also a standard treatment for breathlessness, but it works only for a short time. When I have felt breathless, although I am far from asthmatic, I have taken a blast of steroid inhaler and felt better for some hours. What I fear is that this category of patients are going to be ignored but with treatable respiratory issues, and descend into respiratory failure.

The worst categories fall broadly into two parts (and I am speaking very generally here) Pneumonia on its own causing respiratory failure and also sepsis. I suspect that the younger patients who have no underlying conditions who have died have developed sepsis. The latter is the most dangerous, and can cause death within a few hours. This is not a new phenomenon. Sepsis is when the infection is not just the lungs but the whole body and organs just PUFO. Ventilatory support during sepsis is vital, whilst the medics can get to work sorting out getting the other organs working again. Blood transfusion is important* and is a very important reason that if you are OK, donate blood NOW. Difficult if the onus is on self-isolating but we are going to need the red stuff in huge quantities soon.

Would I want to be ventilated if the need arise? I would stick the tube down my own bronchus and squeeze the bag myself!

*Get the crimson in me Jim son!
Be gone with your qualified insight and empirical knowledge- we don’t want your sort round here!
 
I'm not going to be the person who colects your Rhino essence, so if that's what is needed, I'm afraid you are screwed
It's in the national interest, all in this together remember.
 
I did post something a while back about what I had observed (no scientific or statistical basis to it). I work in a high proportion BAME area (over 50% I believe). I noticed that certain groups were much less likely to follow the social distancing recommendations in force at that time (pre-lockdown). Whether that is cultural, ignorance or just plain 'f*** you I'm alright Jack' I would not know. Now would be about the time when that failure to separate comes home to roost.

It is also entirely possible that the BAME group have a higher proportion of people who cannot work from home, so they are therefore more likely to catch CV.
I did notice all the media images of carnage and panic buying, and random people wearing darth vadar style homemade PPE all seemed to share mainly one common denominator. The selfish version of ‘survival of the fittest’ instinct does appear to kick in much earlier with some.
 

Sarastro

LE
Kit Reviewer
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This is the category (which I fall into) where things like typical asthma inhalers could be useful, but the press does not focus on this. A steroid inhaler could be immensely useful here. You know, the brown one? The blue one, salbutamol is also a standard treatment for breathlessness, but it works only for a short time. When I have felt breathless, although I am far from asthmatic, I have taken a blast of steroid inhaler and felt better for some hours. What I fear is that this category of patients are going to be ignored but with treatable respiratory issues, and descend into respiratory failure.
Curiously this has been exactly my experience (apart from the failure bit, so far). Friend is a respiratory registrar and told me not to grizz it out and call 111, but despite having reasonably bad score on the O2 test the day I called, the answer was basically: you'll probably be fine, call 999 if you really can't breathe.

This may be corraling of scarce resources, I don't know how many steroid inhalers the UK has, but the planner in me does agree with you that a better strategy might be to shotgun the small fix (hand steroid inhalers) earlier rather than have to deal with the big fix (999 callout and ventilator) later.

That said, I'm not dead yet, so perhaps it was the right call. Given the necessity of doing a lot of the diagnosis remotely, a lot of these decisions are inevitably going to be coin tosses.

PS Was hoping the thread wouldn't have to point out that not breathing is fatal entirely independently of whether you have COVID or are on a ventilator, but apparently necessary.
 

diverman

LE
Book Reviewer
Apparently when you have the Covid 19 - your lungs fill with fluid and that's why you have diffidently breathing. Now ventilators are designed for helping people breathe that have things like brain damage etc. However if the lungs are 'full of fluid' and are literally just 'air bags', forcing air into the lungs - pressurises the fluid in the lungs and forces it into the lungs walls - causing more damage.

Can anyone that's a doctor, or medical expert confirm? I don't want some ned type binman giving his opinion - only those with actual medical knowledge should respond.

Cheers.
Three things a) with an endotracheal tube in situ you can suction the fluid out b0 by plcing an end expiratory pressue you can force the fluid back into the circulatory system c) by removing fluid from the body eother by diuretics or haemofiltration you can dehydrate the patient, substitute volume for vaso-pressors toclose the circulation to maintain blood pressure.
 

ExREME..TECH

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Yet another COVID-19 boring thread
 
Yet another COVID-19 boring thread
And yet you found the time to give a reply....if it's boring for you, why did you even bother clicking on the link - and then waste your time replying?
 
Amazing: media now reporting ventilators for CV19 mostly do more harm than good

In a previous thread Tim asked about Covid-19 ICU survival rates. This is dated but useful:

When we mechanically blow air into your damaged lungs faster and harder than humanly possible, ventilator-induced lung injury may result. Generally, for a person to tolerate the undertaking, we have to sedate them, leading to immobility and severe weakness. While sedated, the person cannot cough or clear their airway effectively, leading to superimposed bacterial pneumonia.

This is an awful lot to survive. And in the case of Covid-19, the preliminary outcome data is rather dismal. On Monday, the New England Journal of Medicine published a case series of very ill Covid-19 patients in Seattle with data up to March 23: of the twenty patients who went on a ventilator, only four had so far escaped the hospital alive. Nine had died. Three remained in suspended animation, going on three or four weeks of ventilation. Four escaped the ventilator but remained in hospital.

It's not a pleasant read.
 

ExREME..TECH

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And yet you found the time to give a reply....if it's boring for you, why did you even bother clicking on the link - and then waste your time replying?
To tell you it is fcuking boring? You think I bothered reading it.
I remember when it wasn't a COVID-19 website
 
Amazing: media now reporting ventilators for CV19 mostly do more harm than good

In a previous thread Tim asked about Covid-19 ICU survival rates. This is dated but useful:

When we mechanically blow air into your damaged lungs faster and harder than humanly possible, ventilator-induced lung injury may result. Generally, for a person to tolerate the undertaking, we have to sedate them, leading to immobility and severe weakness. While sedated, the person cannot cough or clear their airway effectively, leading to superimposed bacterial pneumonia.

This is an awful lot to survive. And in the case of Covid-19, the preliminary outcome data is rather dismal. On Monday, the New England Journal of Medicine published a case series of very ill Covid-19 patients in Seattle with data up to March 23: of the twenty patients who went on a ventilator, only four had so far escaped the hospital alive. Nine had died. Three remained in suspended animation, going on three or four weeks of ventilation. Four escaped the ventilator but remained in hospital.

It's not a pleasant read.
All Media?
 
To tell you it is fcuking boring? You think I bothered reading it.
I remember when it wasn't a COVID-19 website
Don't read it then - problem solved!
 
I think you may have mistaken cause and effect here. Yes, 50% of those with COVID who are on ventilators are dying but it's the COVID that's doing that not the ventilation. For people with COVID who need to be ventilated but either can't or don't want to be, the number is a lot closer to 100%
Is that because of lack of oxygen to the brain? If so - is there not a machine that can get hooked up to your veins that gets the blood - puts oxygen in it and then pumps it back into the body? Would this not work:

ECMO for chronovirus
 
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mercurydancer

LE
Book Reviewer
Curiously this has been exactly my experience (apart from the failure bit, so far). Friend is a respiratory registrar and told me not to grizz it out and call 111, but despite having reasonably bad score on the O2 test the day I called, the answer was basically: you'll probably be fine, call 999 if you really can't breathe.

This may be corraling of scarce resources, I don't know how many steroid inhalers the UK has, but the planner in me does agree with you that a better strategy might be to shotgun the small fix (hand steroid inhalers) earlier rather than have to deal with the big fix (999 callout and ventilator) later.

That said, I'm not dead yet, so perhaps it was the right call. Given the necessity of doing a lot of the diagnosis remotely, a lot of these decisions are inevitably going to be coin tosses.

PS Was hoping the thread wouldn't have to point out that not breathing is fatal entirely independently of whether you have COVID or are on a ventilator, but apparently necessary.
Steroid inhalers are available in hundreds of thousands. Standard treatment.
 

ExREME..TECH

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Chopper and 5g isn't helping is it fella?
Dude, there's over a billion things on the internet to read and reply too - if all you have to do in your life is troll threads on here and annoy people - you're going on my ignore list, goodbye forever - you wingnut!
 
I noticed a couple of days ago that a photo of the "first six NHS workers" to pass away were all middle aged BAME.

That could of course simply be a reflection of the demographic make up of the NHS. Still odd.

One wonders if there are any trends in victim types that are being under-reported due to one sensitivity or another? On the same topic, I wondered whether, for example, e-cig or recreational drug use was a factor in some of the younger "no underlying health problems" victims?
From the most recent report on ICU cases. Compares covid-19 with pneumonia.

Report on 2249 patients critically ill with COVID-19


demographics.png


Link to full report: ICNARC – Latest news

As you can see covid-19 is more prevalent in BAME than pneumonia.
 
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