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UChicago doctors see ‘remarkable’ success using ventilator alternatives

uchicagomedicine.org

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Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#91

Post by StavrosK »

raverbashing wrote: post #48
lonelappde wrote: post #21

Earlier quoted context omitted.

RCT is not all of science. RCT is just one (very powerful) tool for making information quantifiable and for making decisions under uncertainty.

This, exactly. The fixation on RCTs has kinda become "a meme" at this point. However it's lives on the line in some situations. Not everything can be double-blind. Not every experiment can be ethically done with a placebo (or done at all). Also the placebo effect is real but it is more pronounced in things like back pain or headaches, not so much in broken bones or aggressive viruses.

You don't need to have a placebo to do a controlled trial, you can just have a control arm of people you administer nothing to. How are you going to know if you have an improvement if you don't have something to compare your treatment to, though?

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#92

Post by james-mcelwain »

jonkho wrote: post #87
james-mcelwain wrote: post #63

Earlier quoted context omitted.

It's not like we're going around incubating healthy people -- you have to be pretty sick to get put on a ventilator. Even if the treatment turns out to be a net negative, most of these patients didn't have very good odds in the first place, so it's pretty unlikely it would affect the death rates "drastically."

Sources? I would disagree, reports show that by not intubating, outcomes are dramatically improved. [1][2] [1] https://www.bloomberg.com/news/articles/2020-04-22/almost-9-... [2] https://www.reuters.com/article/us-health-coronavirus-ventil...

I'm taking issue with the use of the word "dramatically" not the claim that it could improve patient outcomes.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#93

Post by mmsimanga »

fragmede wrote: post #43
not_a_moth wrote: post #24

Earlier quoted context omitted.

Yes, rather absurdly, I learned about him like a month ago on ZeroHedge when they started following him; he was brushed off for weeks, his message being, "Look at patient behavior, this is not actually ARDS, our ventilator strategy is probably wrong." Crazy to think that so many doctors around the world, experts, and policy makers didn't really question the fundamental nature of the disease, and perhaps telling that…

Dr Ignaz Semmelweis had this ludicrous theory, back in 1846, of “cadaverous particles” causing high deaths in women who had just given birth. Despite evidence that it worked , he spent the rest of his life trying to get people to listen. The doctors of the day were so threatened by the possibility that they were the ones killing their patients that they rejected the practice. We haven’t culturally evolved much furthe…

Side note, my wife spent two years studying in Vienna. As a result my daughter was born at Semmelweis Hospital. I took some time to read about Semmelweis and he seems to have been ahead of his time. Great contributor to medicine.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#94

Post by tomohawk »

loeg wrote: post #78

The article mentions 40% O2 sat to 80 or 90%; aren't the latter still really low? I'm certainly no doctor, but wikipedia[1] claims "Prolonged hypoxia induces neuronal cell death via apoptosis, resulting in a hypoxic brain injury" and suggests that 80-85% is considered severe and 86-90% moderate. Granted, both are a hell of a lot better than 40%! It adds, "Mild and moderate cerebral hypoxia generally has no impact bey…

Being on a ventilator is traumatic. So much so that they generally put you under. Can you imagine waking up with a tube through your mouth and down your throat forcing you to breathe? It happens and people panic and have to be restrained. People get PTSD.

https://www.hopkinsmedicine.org/news/media/releases/ptsd_com...

If you can get the O2 up to a livable level without a ventilator so that the patient is supported enough to get well, that that is a good outcome.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#95

Post by gus_massa »

caymanjim wrote: post #60
gus_massa wrote: post #40

Earlier quoted context omitted.

> Unfortunately, in the middle of a pandemic, that's not going to happen with enough speed to prevent a lot of people dying. How are you sure that this method is not worse than the ventilator method and will kill even more people during the pandemic? How many death did they get with this method? How many death would they had got with the ventilator method?

90% of people on ventilators die. It's hard to do much worse. And with numbers like that, I think it's perfectly ethical to try anything reasonable.

What is the original source of the 90%? Is it from this article: https://jamanetwork.com/journals/jama/fullarticle/2765184

From the article:

> The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates.

> As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital.

If you ignore the 831 patients that were still in the hospital, and consider only the 38 that survived and the 282 that died, you get 282/(282+38)=88%. It is a very short time. What are the odds for people that survive more than 4 days in the hospital?

Did the team this post get the better results using the same accounting method? Did they apply this method only to the people that would need a ventilator or to more people because it is cheaper and easier to setup and maintain? (IIUC they used ventilator for the worse cases anyway.)

> And with numbers like that, I think it's perfectly ethical to try anything reasonable.

Do you want the best possible treatment to each patient, or you prefer that each doctor tries his/her pet theory in production?

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#96

Post by polishTar »

tomohawk wrote: post #94
loeg wrote: post #78

The article mentions 40% O2 sat to 80 or 90%; aren't the latter still really low? I'm certainly no doctor, but wikipedia[1] claims "Prolonged hypoxia induces neuronal cell death via apoptosis, resulting in a hypoxic brain injury" and suggests that 80-85% is considered severe and 86-90% moderate. Granted, both are a hell of a lot better than 40%! It adds, "Mild and moderate cerebral hypoxia generally has no impact bey…

Being on a ventilator is traumatic. So much so that they generally put you under. Can you imagine waking up with a tube through your mouth and down your throat forcing you to breathe? It happens and people panic and have to be restrained. People get PTSD. https://www.hopkinsmedicine.org/news/media/releases/ptsd_com... If you can get the O2 up to a livable level without a ventilator so that the patient is supported en…

I suppose I’d rather risk the 1/4 chance of getting ptsd vs the guarantee of moderate/severe brain injury if it was a choice

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#97

Post by fhars »

StavrosK wrote: post #91
raverbashing wrote: post #48

Earlier quoted context omitted.

This, exactly. The fixation on RCTs has kinda become "a meme" at this point. However it's lives on the line in some situations. Not everything can be double-blind. Not every experiment can be ethically done with a placebo (or done at all). Also the placebo effect is real but it is more pronounced in things like back pain or headaches, not so much in broken bones or aggressive viruses.

You don't need to have a placebo to do a controlled trial, you can just have a control arm of people you administer nothing to. How are you going to know if you have an improvement if you don't have something to compare your treatment to, though?

You need the placebo for the double blind RCT, which is still kind of the gold standard. But pronating patients is hard to do in a double blind fashion, so it is less of an issue here.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#98

Post by gus_massa »

fhars wrote: post #97
StavrosK wrote: post #91

Earlier quoted context omitted.

You don't need to have a placebo to do a controlled trial, you can just have a control arm of people you administer nothing to. How are you going to know if you have an improvement if you don't have something to compare your treatment to, though?

You need the placebo for the double blind RCT, which is still kind of the gold standard. But pronating patients is hard to do in a double blind fashion, so it is less of an issue here.

The double blind part is very difficult, but at least they can have a randomized control group [1]. It doesn't sound very difficult.

Also, in most cases the control group get the "standard" treatment, because "do nothing" (taking literally the GP) is too bad. And you want to be sure that the new treatment is better than the "standard" treatment.

[1] A real randomized control group, not an unrelated bunch of guys in another city of France.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#99

Post by arcticbull »

achillesheels wrote: post #84
mmkhd wrote: post #77

Earlier quoted context omitted.

> they will let their patients and colleagues die first. No! They will definitively not let their patients and colleagues die firs! They will prevent you from killing them! You might believe in youRe therapy, but the vast amount if novel therapies will have (novel) adverse effects and you will haVe to supply the prove that your therapy will do less harm than doing the conventional thing. We have clinical trials to ad…

Please explain to me the risks of nebulized ethyl alcohol, which is what I am proposing? Ad hoc dismissals without the consideration of scientific literature reviews of alcohol inhalation - which there are several review papers published - demonstrates a serious lack of critical thought in medicine. Obviously to compare it to chloroquine is absurd. Your point about supplying the safety data is exactly where the roadb…

> I’ll update you when the device is approved by the FDA and voila these objections mysteriously disappear ;)

You know a proper FDA approval takes years, right? Not the emergency do-whatever-you-want approval, a proper approval. By all means, please do post.

Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives

#100

Post by 1996 »

ceejayoz wrote: post #32
mrfusion wrote: post #22

I heard on Reddit that Medicare pays 3x more for intubation. Can anyone find a source?

It’s a far more complicated procedure, of course it pays more. A five year old can install a nasal cannula.

and it could be done at home, using an O2 cannister, that should be cheap even for those paying out of pocket without medical insurance.

no wonder why the medical establishment would be opposed to a simple work around that would remove the need for hospitalization or ICU

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