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The U.S. tried to build a new fleet of ventilators

nytimes.com

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Re: The U.S. tried to build a new fleet of ventilators

#71

Post by gjhan »

Nambia wrote: post #23
toomuchtodo wrote: post #9

Earlier quoted context omitted.

There is a narrow range of pressure where you're not damaging the alveoli from underpressure, but not bursting the lungs from overpressure. You need a mechanical scalpel, not a butcher's knife.

Honest question: is the pressure range actually that narrow? People can survive at high altitudes, which will see pressure of 70% sea level (or less, especially when considering mountain climbing). Additionally, when SCUBA diving, something like 30 feet of depth = 1 atmosphere. I feel like I'm missing something here. Any ideas?

As you point out, the body can tolerate significant variation in absolute pressure, corresponding to the temperature, composition, and density of the gas you breathe.

The pressure that must be narrowly controlled in a ventilator application is the relative pressure: the difference between the absolute pressure outside the lung (in the room) and the absolute pressure inside the lung. This relative pressure is what does all the work --- mechanically opening airways and alveoli --- and could cause all the injury.

Re: The U.S. tried to build a new fleet of ventilators

#72

Post by AnthonyMouse »

pdonis wrote: post #4
m0xte wrote: post #2

I’ve always said that governments should use our tax money to design and validate key health and infrastructure components and only outsource manufacturing and only to local businesses. Governments are so utterly broken and inefficient that they can’t do it. However even if they produced a design now we have supply chain problems globally. Edit: I seem to have stirred up capitalist defence here. To clarify: The gover…

> Governments are so utterly broken and inefficient that they can’t do it. Exactly. Which means we should not be depending on governments to do it. This is exactly the sort of thing that private startup companies should be doing, without trying to involve the government's bloated and inefficient bureaucracy. > even if they produced a design now we have supply chain problems globally For this particular crisis, yes. B…

> For this particular crisis, yes.

Really not even for this particular crisis. We can build more of something on a short timescale, it just costs more then. You have to build facilities you know are only going to run for six months and then be decommissioned, so you have to amortize their construction cost over half a year instead of 30 years. You have to build them on the double, which means paying a lot of overtime and buying land and raw materials without taking a lot of time to negotiate on price or worry about efficiency. But we could do it.

And then the ventilators would cost ten times more than they ordinarily do and idiots would accuse anybody trying to do this of price gouging. But it could be done. (Unless the idiots pass a law against charging more than the regular price during an emergency.)

Re: The U.S. tried to build a new fleet of ventilators

#73

Post by cycrutchfield »

choeger wrote: post #69
cycrutchfield wrote: post #65

Earlier quoted context omitted.

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

Look how radiologists work nowadays. They don't see their patients face to face. Everything except the decision making has been handed to someone else so they can be most efficient. That's the model a huge COVID19 ICU could work like.

Still, it’s an ICU, not an outpatient clinic. I think you are a bit over-optimistic about just how much care can be delegated.

Re: The U.S. tried to build a new fleet of ventilators

#74

Post by ALittleLight »

cycrutchfield wrote: post #65
ALittleLight wrote: post #62

Earlier quoted context omitted.

Really? They spend 8 years learning how to operate a ventilator? Medical professionals learn how to do their entire job in a similar time frame. Ventilator operation is surely a small part of that. I'd be astonished if it would take someone more than a week or two to learn the basic mechanics of how to use a ventilator. None of the theory or nuances, but a course that says "hook it up like this, do X, Y and Z and com…

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

I'm not saying "zero training". I'm suggesting the minimum training necessary to run a ventilator. That way doctors or nurses could simply hand off care to ventilator-operators who could contact the doctor or nurses if things got out of control. This wouldn't be as high quality care as people would usually get, but hopefully it would be better than nothing.

Regarding whether doctors would want undertrained help - that's immaterial. If current healthcare workers have the capacity to handle the pending wave of sick people, then that's great and we shouldn't get in their way. If they have another, better solution, then let's do that. If the alternative to having minimally trained people operate ventilators is letting people die without any intervention - I'd want to see some explanation or evidence as to why letting people die is better.

Re: The U.S. tried to build a new fleet of ventilators

#75

Post by naringas »

oefrha wrote: post #30

I find it strange that all we hear about these days is the shortage of ventilators (okay, PPE too), as if it’s the only bottleneck. The reality is ventilators are useless without intensivists to operate them, and you need anesthesiologists and probably other skilled personnel too. I learned through a personal connection who was actually on the ground in Hubei (but not Wuhan) caring for serious but non-ICU patients th…

> It’s much harder to ramp up production of medical professionals.

and the fact that we think about "ramping up production" of "medical personel" leads the way to terrible industry-like education systems which emphasize cost-efficiency rather than quality education.

Re: The U.S. tried to build a new fleet of ventilators

#76

Post by germinalphrase »

throwawaynerdy wrote: post #42
dTal wrote: post #6

Earlier quoted context omitted.

Have you considered that maybe broken inefficiency is not necessarily a property of governments in general? The local optimum might be to avoid having the government do things, but the global optimum is to fix your government.

If you look at history, I'm not sure it's possible for a government to get better. I'm not aware of any historical examples. Revolution can happen, but that means a new government.

They clearly work well enough they every functioning society on earth utilizes one. What is your counterexample in which a government-less society flourished?

Re: The U.S. tried to build a new fleet of ventilators

#77

Post by corebit »

cycrutchfield wrote: post #65
ALittleLight wrote: post #62

Earlier quoted context omitted.

Really? They spend 8 years learning how to operate a ventilator? Medical professionals learn how to do their entire job in a similar time frame. Ventilator operation is surely a small part of that. I'd be astonished if it would take someone more than a week or two to learn the basic mechanics of how to use a ventilator. None of the theory or nuances, but a course that says "hook it up like this, do X, Y and Z and com…

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

This speaks volumes about the cronyist regulatory captured monopoly that the AMA has been able to install over the past hundred years.

Re: The U.S. tried to build a new fleet of ventilators

#78

Post by landryraccoon »

Nambia wrote: post #23
toomuchtodo wrote: post #9

Earlier quoted context omitted.

There is a narrow range of pressure where you're not damaging the alveoli from underpressure, but not bursting the lungs from overpressure. You need a mechanical scalpel, not a butcher's knife.

Honest question: is the pressure range actually that narrow? People can survive at high altitudes, which will see pressure of 70% sea level (or less, especially when considering mountain climbing). Additionally, when SCUBA diving, something like 30 feet of depth = 1 atmosphere. I feel like I'm missing something here. Any ideas?

Covid patients in the ICU probably don’t have healthy lungs. The people you’re talking about at those pressure ranges are probably all young, healthy and athletic.

I know a bit about scuba diving, and you absolutely are not supposed to go diving if you have a lung injury.

I would speculate that if you put a person with serious covid on a mountain top or 30 meters under the ocean it would kill them pretty quickly..

Re: The U.S. tried to build a new fleet of ventilators

#80

Post by [deleted] »

ALittleLight wrote: post #62
cycrutchfield wrote: post #48

Earlier quoted context omitted.

About 4 years of medical school, and around 4 more years of residency training.

Really? They spend 8 years learning how to operate a ventilator? Medical professionals learn how to do their entire job in a similar time frame. Ventilator operation is surely a small part of that. I'd be astonished if it would take someone more than a week or two to learn the basic mechanics of how to use a ventilator. None of the theory or nuances, but a course that says "hook it up like this, do X, Y and Z and com…

[deleted]
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