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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

#81

Post by hutzlibu »

joshgel wrote: post #12
DanielBMarkham wrote: post #7

One 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 wo…

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.

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

#83

Post by 8bitsrule »

achillesheels wrote: post #58
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…

Yes it is. Frankly my view of the medical professional community is much lower now. MDs are really just glorified infantry on the frontlines. The lack of creativity, which presupposes degrees of original and independent thought, is striking.

Of course we need to factor in malpractice lawsuits, administrative restrictions, tidal paperwork etc. etc. into anything which may have happened to medical professionals' creativity.

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

#84

Post by achillesheels »

mmkhd wrote: post #77
achillesheels wrote: post #57

Earlier quoted context omitted.

And unfortunately, there are doctors that will not make a move on an experimental therapy without it going through IRB approval, as I am learning with my own efforts at introducing a portable nebulizer biocidal therapy. Some will not take chances unless they see safety data first - they will let their patients and colleagues die first. As a former biomedical engineering researcher, this pandemic has been profoundly e…

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

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

#85

Post by NineStarPoint »

achillesheels wrote: post #58
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…

Yes it is. Frankly my view of the medical professional community is much lower now. MDs are really just glorified infantry on the frontlines. The lack of creativity, which presupposes degrees of original and independent thought, is striking.

There are, rightly or wrongly, strong incentives to not be creative. To do the thing the medical consensus recommends, even if it is incredibly flawed, leaves the doctor personally safe. To try an experimental idea on your own could get you sued for medical malpractice. Which is I suppose to say, that MDs have been given a strong incentive by our system to suppress creativity.

(Personally, I think there’s a good reason for this in normal times. Medical research is hard and personal opinion will never compare to years of research, especially when lives are on the line. In times where years of research aren’t actually an option though...)

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

#86

Post by W_G_T »

40four wrote: post #9

Sounds 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.

They converted the entire MICU (24 beds) to negative pressure rooms.

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

#87

Post by jonkho »

james-mcelwain wrote: post #63
jonkho wrote: post #38

Earlier quoted context omitted.

Also, how does this affect the actual death rate numbers in NYC if unnecessary deaths caused by outcomes of ventilator use are factored into the picture? Could change the picture quite drastically.

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...

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

#88

Post by randcraw »

newacct583 wrote: post #54
joshgel wrote: post #12

Earlier 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...

If that study takes a few months to finish, be reviewed and published, it's very clearly not "better". Science is important, but there are times like this where brute intuitive engineering is the only tool available.

All engineering needs feedback to guide implementation, especially in complex systems. And it's essential in black box systems like biological organisms. This is why the words engineering and medicine intersect mostly in relatively uncomplicated areas like prosthetics or eyeglasses. In immune systems, engineering is used only in the earliest stages, like to reduce search spaces in development of synthetic antigens and antibodies for vaccines, never to guide clinical trials. There feedback drives all decisionmaking under the purview of statisticians only. Engineering, and especially intuition, plays no role al all.

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

#89

Post by reticular »

I don't doubt that this works well but there is a good reason that other hospitals are not using this approach. As the article mentions:

"This approach is not without risk, however. HFNCs blow air out, and convert the COVID-19 virus into a fine spray in the air. To protect themselves from the virus, staff must have proper personal protective equipment (PPE), negative pressure patient rooms, and anterooms, which are rooms in front of the patient rooms where staff can change in and out of their safety gear to avoid contaminating others."

"UChicago Medicine’s Emergency Department recently doubled its number of anterooms, thereby doubling its capacity to give ?high-flow nasal cannula to patients. The main hospital also added negative pressure rooms on two floors, making it safer and easier to take care of COVID-19 patients."

Not all hospitals have the ability to double the number of negative pressure rooms or even provide needed PPE to all caregivers.

A ventilator on the other hand allows for a HEPA filter in-line that prevents the spread of the disease within the hospital.

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

#90

Post by kgwgk »

abakker wrote: post #80
joshgel wrote: post #12

Earlier 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...

If the effect size is large, the benefits of randomization go down. A very effective treatment would be evidently very effective without the burden of statistical proof. The randomization is critical when you are looking to differentiate small effects from random noise. That said, large effect sizes in one hospital don’t control for confounding variables.

Randomization is not required to neutralize random noise, which is... random.

It’s required to prevent systematic biases like giving the drug that you think might help to the patients with better prognosis (instead of wasting it on those that are very likely to die anyway).

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