UChicago doctors see ‘remarkable’ success using ventilator alternatives
uchicagomedicine.org
UChicago doctors see ‘remarkable’ success using ventilator alternatives
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Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#2I'm an intensivist based in Sweden. From my perspective there is absolutely nothing new in this article. We have been using HFC for years if not decades.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#3I'm an intensivist based in Sweden. From my perspective there is absolutely nothing new in this article. We have been using HFC for years if not decades.
As I understand it, what's new is that it's being used under these circumstances. The ARDS algorithm would have these patients be intubated. Instead, they're putting these patients on HFC and letting them get hypoxic, reasoning that the mixture of damage caused by the infection and the vent is what's fatal.
Edit: Also, people have been avoiding HFC for COVID-19 because of aerosolization risks.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#4I'm an intensivist based in Sweden. From my perspective there is absolutely nothing new in this article. We have been using HFC for years if not decades.
As I understand it, what's new is that it's being used under these circumstances. The ARDS algorithm would have these patients be intubated. Instead, they're putting these patients on HFC and letting them get hypoxic, reasoning that the mixture of damage caused by the infection and the vent is what's fatal. Edit: Also, people have been avoiding HFC for COVID-19 because of aerosolization risks.
this is my understanding as well.
when i was an EMT if someone had O2 sats in the 50s and was conscious i would’ve told you that the pulse ox was broken. And it it wasn’t broken, i’d be yelling for a paramedic to tube my patient asap.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#5One of the most active figures in this debate has been a New York doctor named Cameron Kyle-Sidell. He frequently posts interesting sources on Twitter:
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#6I'm an intensivist based in Sweden. From my perspective there is absolutely nothing new in this article. We have been using HFC for years if not decades.
Not for COVID-19, presumably.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#7One of the most interesting parts of this press release, following it on other boards, is the immediate "We already do that. Nothing new here."
That kind of reply would immediately lead me to think it was just a useless release, but then I see people posting comments along the lines of "No, we don't do that. In fact, we have a policy against doing that because of the danger of aerosolization"
For my hacker/systems wonks, this a great example of group learning happening world wide. I imagine there are many ICUs that do this, and many that forbid it. In such an environment, releases like this aren't submarines or spam; they're recurring prompts to administrators elsewhere that they might be missing something important.
I hate to sound cold, but damn this is an interesting example of how organizations learn. One commenter asked "I wonder how many of those hospitals who forbid intubation are doing it to patients with good insurance"
For the record, as far as I know this is a horrible thing to suggest. But the overall point, that large organizations have incentives that are many times removed from the actual work being done, is a good one.
This kind of conversation facilitation across borders is what the internet was supposed to be doing. I think this is the first time I've seen it working the way we had hoped. What's especially interesting to me is that many of the signals we look for in social forums, like "this is just a spam press release", "nothing new to see", or "there's some ulterior motivation here" voting up or down, etc., are actually counter-indicators and inhibitors of overall progress.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#8Earlier quoted context omitted.
As I understand it, what's new is that it's being used under these circumstances. The ARDS algorithm would have these patients be intubated. Instead, they're putting these patients on HFC and letting them get hypoxic, reasoning that the mixture of damage caused by the infection and the vent is what's fatal. Edit: Also, people have been avoiding HFC for COVID-19 because of aerosolization risks.
this is my understanding as well. when i was an EMT if someone had O2 sats in the 50s and was conscious i would’ve told you that the pulse ox was broken. And it it wasn’t broken, i’d be yelling for a paramedic to tube my patient asap.
My non-medical understanding is that the long term damage threat of the disease is primarily due to to organs dealing with low oxygen for long periods of time. Would you say it's fair to say that an approach which saved more lives by not addressing would probably leave a greater proportion with organ damage?
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#9Sounds like a promising strategy to manage patients, assuming the hospital has the necessary negative pressure rooms, etc. Especially since ventilators don’t even seem to be very effective. We’ve been seeing stories last few days that the large majority (88%) of folks put on ventilators in NYC, end up dying.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#10Earlier quoted context omitted.
this is my understanding as well. when i was an EMT if someone had O2 sats in the 50s and was conscious i would’ve told you that the pulse ox was broken. And it it wasn’t broken, i’d be yelling for a paramedic to tube my patient asap.
My non-medical understanding is that the long term damage threat of the disease is primarily due to to organs dealing with low oxygen for long periods of time. Would you say it's fair to say that an approach which saved more lives by not addressing would probably leave a greater proportion with organ damage?
honest answer? we have absolutely no idea, and whether or not we like it (mostly we don't like it), we're in the process of finding out.