I wonder how this technique differs from CPAP. CPAP doesn't use pure O2, but perhaps the pressures can be similar?
UChicago doctors see ‘remarkable’ success using ventilator alternatives
111–120 of 123 posts
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#112Earlier quoted context omitted.
'No evidence' that recovering from Covid-19 gives people immunity, WHO says https://www.france24.com/en/20200425-no-evidence-that-recove...
There was no evidence of human-to-human transmission early on, too. “No evidence” is not “evidence against immunity”. It means we don’t know yet.
> There was no evidence of human-to-human transmission early on, too.
I have two comments about that:
1) Like somebody else said, if you don't look, you won't find evidence, even if it's there.
2) Wuhan officials were incentivized to say it wasn't contagious, ergo, no lockdown needed.
However, it clearly was being transmitted to non-wet market patients in late Nov./early Dec., and Disneyworld Shanghai was closed Jan. 24, so you have to be wilfully blind to say it's not contagious.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#113Sound a lot like the devices people criticized Tesla for delivering.
Yes, it turns out the Tesla devices were actually more practical than first thought.
The caveats are:
1) Would US hospitals accept or recommend them?
2) If US hospitals accepted them, was there an acceptable solution to the aerosolization problem? Wuhan hospitals were segregated into corona and non-corona locations, so aerosolization wasn't a problem for other patients, but I don't know if US hospital systems got that organized.
I highly recommend reading the Wuhan accounts and papers. They really moved fast on improving their response, which the US totally ignored. Only now, Apr. 26, are we catching up to what they found in Jan./Feb. I doubt if it affected the body count much, but time was wasted.
Instead HN wasted months on endless navel-gazing and "IFR vs. CFR" chatter. Really a new low for HN.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#114Earlier 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.
In some cases, the placebo is a currently approved treatment.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#115Earlier quoted context omitted.
Even better would be randomized experimental data that this was better than an alternative... 'It works' can mean lots of different things...
"'It works' can mean lots of different things..." "The proning and the high-flow nasal cannulas combined have brought patient oxygen levels from around 40% to 80% and 90%, so it’s been fascinating and wonderful to see" People die, if their oxygen levels are getting too low. This method gets them up again. Sounds like "working" to me.
We aren’t treating oxygen levels. Higher oxygen levels now that result in lower oxygen levels later might actually be a bad thing.
I have no doubt that proning increases the readings we are getting on pulse ox monitors, sometimes pretty immediately. I’ve seen it, literally first hand, in a number of my patients. But I have no idea if it saves lives. Many of those same patients still got intubated and some died.
Understanding impact on surrogate markers isn’t enough.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#116Earlier 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?
This is "decision making under conditions of uncertainty." [0] It's not that your questions are bad, it's that in practice medical professionals have to operate without answers to them. Doing so involves communication with peers about their own observations of what may work better/worse, such as in this article. Double-blind randomized trials are not the only source of actionable information: Case studies also form a…
One of the lesson of the physics lab is that unless you have calibrated very carefully all the equipment and experimental setup, you can't mix the measurements of one day with the measurements of another day.
For example one day we have very weird results trying to compare two measurements of the same day about something related with the speed of sound. After a lot of time trying to understand the problem we notice that one measurement was from 9am when the temperature was like 10°C(50°F) and the other was from 1pm when the temperature was like 25°C(77°F). The following days we tried to take all the measurements as close as possible.
The same applies to benchmarks in computers. A few days ago I got an improvement for a program that reduced the runtime from 85s to 59s. Until I noticed that one was with the notebook plugged in an the other with the batteries. I tried again both with the notebook plugged in and the improvement was only from 65s to 59s. Still a nice improvement but not fantastic.
Quoting again part of the original comment I'm repliying
> Learning is not the same as science, and we need randomized trials to actually be sure of anything. Unfortunately, in the middle of a pandemic, that's not going to happen with enough speed to prevent a lot of people dying. The perfect can be the enemy of the good enough.
Without a randomized control group it is very difficult to be sure if a small improvement of the survival rate is real. So you can't learn if the new method or the old method is better.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#117Earlier 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?
> How are you going to know if you have an improvement if you don't have something to compare your treatment to, though? Historical data? Past experiments? Sure, they might have biases, but the higher sample size of historical data can help with that. I think (specific) control groups make sense when you're talking about small effects or very specific cases (for example, the control group will undergo the standard tr…
Historical data is useful as a rough guideline, but it is very difficult to use to make comparisons.
For example: If there is a small Ebola outbreak in New York and you give the patients hydroxychloroquine and the death rate is 80%, is it good or bad?
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#118Earlier quoted context omitted.
There was no evidence of human-to-human transmission early on, too. “No evidence” is not “evidence against immunity”. It means we don’t know yet.
> There was no evidence of human-to-human transmission early on, too. I have two comments about that: 1) Like somebody else said, if you don't look, you won't find evidence, even if it's there. 2) Wuhan officials were incentivized to say it wasn't contagious, ergo, no lockdown needed. However, it clearly was being transmitted to non-wet market patients in late Nov./early Dec., and Disneyworld Shanghai was closed Jan.…
Yes, the WHO is not a spy organization. They rely in large part on cooperation from member nations.
Sometimes that’s an issue, but it doesn’t mean they were lying when they said they didn’t have the evidence yet.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#119Earlier quoted context omitted.
An ad hoc (fallacy) dismissal would be one that doesn't actually address the central question or finds an excuse that is not generalizable to similar circumstance without supporting evidence for the exception. Even if you think the GP's reasoning was wrong, the GP comment did provide specific reasons for their argument, which was itself an argument generalized to medical practice & research. Not ad hoc . Further, if…
Thank you for your reply, but I never claimed an ad hoc fallacy? Nor did I claim infallibility? I am insinuating the disregard for novel therapies in a pandemic because there is no data conceived (ad hoc dismissal or excuse), and not because of an intuitively perceived judgment on its harm, which is readily discernible from the collection of scientific literature on alcohol inhalation I have found and can share, is a…
Also, thank you for a thoughtful response. I can appreciate your eagerness to save lives too, but I would not so easily cast doctors as any less eager. A doctor that avoids experimental treatment is doing so precisely because they believe they are acting in a patient's best interests.
Front-line doctors simple have a different perspective: There are many prospective treatments that might show promise. Most will not work. Many may have their own catastrophic effects. At the same time, doctors must make immediate decisions on how to treat patients, without the luxury of time to review all prospective experimental treatments, most of which lack sufficient data to make a rapid determination of their risk. And remember their foundational, ancient oath: "First, do no harm". If that oath engenders a certain amount of conservatism in treatment choices, you should not berate the doctors themselves as deficient: Your issue is with the fundamental philosophy of medical practice.
I am glad you are hungry to save lives. But remember humility: Any number of significant failures that cost lives can be found will minimal searching, and undoubtedly most involved were eager to save lives as well. The drug combo FenFen comes to mind: I'm sure the researchers involved were eager to save lives and improve the health of obese people, but they're efforts caused serious heart problems in up to 30% of those taking the drug. Medical history is littered with failures and death. You must remember that. If doctors are conservative in their treatment choices, they have good reason, and should not be condemned for it. You'll win no people to your cause if you vilify those you seek to convince, all you will do is attract people who are already inclined to agree with you.
Re: UChicago doctors see ‘remarkable’ success using ventilator alternatives
#120Earlier quoted context omitted.
This is "decision making under conditions of uncertainty." [0] It's not that your questions are bad, it's that in practice medical professionals have to operate without answers to them. Doing so involves communication with peers about their own observations of what may work better/worse, such as in this article. Double-blind randomized trials are not the only source of actionable information: Case studies also form a…
One of the lesson of the physics lab is that unless you have calibrated very carefully all the equipment and experimental setup, you can't mix the measurements of one day with the measurements of another day. For example one day we have very weird results trying to compare two measurements of the same day about something related with the speed of sound. After a lot of time trying to understand the problem we notice t…
Yes, absolutely correct. We just don't always have time to wait: Doctors must take action now. Knowing a majority of people that end up ventilators will die means the balance of risk weighs at least a little more heavily towards novel treatments than in less critical cases.
Case studies of those attempts are exactly the kind of data points that can provide a great deal of information and hypothesis generation for more systematic studies.