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'Pandemic ventilator' could offer solution in potential 'worst case' scenario

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Re: 'Pandemic ventilator' could offer solution in potential 'worst case' scenario

#91

Post by krona »

totalZero wrote: post #45
thornjm wrote: post #35

Earlier quoted context omitted.

Med student here - so I know some of the theory only. The most relevant "law" is Fick's Law of Diffusion ( https://d2jmvrsizmvf4x.cloudfront.net/CTU792sKR2evT2ezizQp_f... ). Doctors can increase diffusion by increasing the partial pressure of oxygen. In a diffuse infection a patient begins to lose both lung area (due to shunting) and the thickness of the diffusion barrier increases (due to inflammation). To help over…

It's too bad we can't put sick people in an airplane, put oxygen masks on them, shut the door, and pressurize the cabin. Like a hospital, but at the airport.

The UK government has already considered this as an option. I don't know what became of it. I don't think we're quite at that stage, yet.

Re: 'Pandemic ventilator' could offer solution in potential 'worst case' scenario

#92

Post by vermilingua »

tcbawo wrote: post #30

If you read enough news and Twitter, you will find some really heartbreaking descriptions of the folks on ventilators. For most, this is a Hail Mary attempt with only 50% survival rate. Many will have significant lung damage if they survive. We need more ventilators to be sure. But we desperately need to find ways to halt the progression of runaway lung inflammation that leads to needing a ventilator. Edit: this deve…

If this is true, the death toll of Covid-19 is going to be a lot worse than currently indicated, is that right?

The complications of ventilators and whatever lasting damage is caused by the disease itself; will be killing a significant portion of the recovered population, will it not?

Re: 'Pandemic ventilator' could offer solution in potential 'worst case' scenario

#93

Post by chriskanan »

notyourday wrote: post #88
tcbawo wrote: post #30

If you read enough news and Twitter, you will find some really heartbreaking descriptions of the folks on ventilators. For most, this is a Hail Mary attempt with only 50% survival rate. Many will have significant lung damage if they survive. We need more ventilators to be sure. But we desperately need to find ways to halt the progression of runaway lung inflammation that leads to needing a ventilator. Edit: this deve…

> For most, this is a Hail Mary attempt with only 50% survival rate. Non Hail-Mary Ventilators have only a 30% survival rate at 1 year mark: https://www.ncbi.nlm.nih.gov/pubmed/8404197 Incidentally, that's exactly why medical systems to not stockpile ventilators. Under reasonable condition, the number of ventilators closely mirrors the expected number of Hail Mary procedures done at a given time and some spare units.

That paper makes me wonder what will be the long-term health consequences and outcomes for the survivors of COVID-19 who needed to stay at an ICU.

Re: 'Pandemic ventilator' could offer solution in potential 'worst case' scenario

#94

Post by AntonStratiev »

notyourday wrote: post #88
tcbawo wrote: post #30

If you read enough news and Twitter, you will find some really heartbreaking descriptions of the folks on ventilators. For most, this is a Hail Mary attempt with only 50% survival rate. Many will have significant lung damage if they survive. We need more ventilators to be sure. But we desperately need to find ways to halt the progression of runaway lung inflammation that leads to needing a ventilator. Edit: this deve…

> For most, this is a Hail Mary attempt with only 50% survival rate. Non Hail-Mary Ventilators have only a 30% survival rate at 1 year mark: https://www.ncbi.nlm.nih.gov/pubmed/8404197 Incidentally, that's exactly why medical systems to not stockpile ventilators. Under reasonable condition, the number of ventilators closely mirrors the expected number of Hail Mary procedures done at a given time and some spare units.

And the survival rate is only 3% to 20% for COVID-19 specifically, based on data from Wuhan, following patients for a month. Long-term mortality will be even less.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Plus you need nurses and doctors to intubate the patient and setup and monitor the actual ventilator. The machine itself is a small part of the equation.

I think the focus on ventilators is somewhat misleading. If you need mechanical ventilation, you're a goner anyway, and your bed and healthcare staff could be better used on someone else. The 'lack' of a machine is just a very visible component.

Re: 'Pandemic ventilator' could offer solution in potential 'worst case' scenario

#95

Post by mrfusion »

baxtr wrote: post #54
war1025 wrote: post #41

Earlier quoted context omitted.

My understanding is that's the hope for Chloroquine and the other drugs being rolled out en-masse this week. They have shown enough promise by various limited trials that we are rolling them out nation-wide to see if they actually do help reduce the severity of the virus. If they do, then less hospitalization, and less ICU / ventilator needs. If Chloroquine doesn't end up working, basically we need to find something…

At this stage it is totally unclear if Chloroquine will work. Unfortunately. Because, all the work published so far has not been produced through double-blind studies in randomized trials.

My god man, totally unclear?

I bet you could find five or more recent peer reviewed studies on it working quite well.

You realize most science isn’t double blind, right? I’ll grant you thats it a gold standard for long term drug use but saying “totally unclear it will work” is absurd.

And we still do useful work relying on simple correlations, r values, peer review. We have all that now supporting some of these drugs. In a crisis and last resort that seems like plenty.

Re: 'Pandemic ventilator' could offer solution in potential 'worst case' scenario

#96

Post by ClumsyPilot »

mike_d wrote: post #76
bamboozled wrote: post #59

Earlier quoted context omitted.

I was going to say the same, there seems to be thread after thread about ventilators, but are they a golden ticket to good health ?

> but are they a golden ticket to good health No, building a ventilator is like building an engine because you need to go to the store - you're missing so much of the solution to the problem. I've also posted before [1] on why they are a terrible idea to waste time on "designing". That said, ventilators I believe are already a solved problem for COVID. We have tens of thousands in the strategic stockpile, and product…

It absolutely isnt a solved problems, most countries affected by the pandemic do not manufacture the ventilators and have like a 10x shortage compared to what's needed to incubate everyone who will be sick. (Obviously depending on how bad it gets).

The struggle to ramp up production is a desperate one, and this is one case where IP is killing people - there are several consortia in the UK that are ready to manufacture, but need a certified design they could build.

Re: 'Pandemic ventilator' could offer solution in potential 'worst case' scenario

#97

Post by Zigurd »

mrfusion wrote: post #95
baxtr wrote: post #54

Earlier quoted context omitted.

At this stage it is totally unclear if Chloroquine will work. Unfortunately. Because, all the work published so far has not been produced through double-blind studies in randomized trials.

My god man, totally unclear? I bet you could find five or more recent peer reviewed studies on it working quite well. You realize most science isn’t double blind, right? I’ll grant you thats it a gold standard for long term drug use but saying “totally unclear it will work” is absurd. And we still do useful work relying on simple correlations, r values, peer review. We have all that now supporting some of these drugs…

"Peer reviewed" is a better assurance of the accuracy of the observation. It can't do anything about the fact that evidence for current treatment attempts is purely based on observations that could be the result of hope and the placebo effect.

Furthermore, there is a difference between observations of aggregate numbers, like the number of people on ventilators and their survival rate, and small numbers of uncontrolled drug interventions where there are obvious ways for the data to be deceiving. Not all observed data has the same reliability.

Re: 'Pandemic ventilator' could offer solution in potential 'worst case' scenario

#98

Post by Fargren »

vermilingua wrote: post #92
tcbawo wrote: post #30

If you read enough news and Twitter, you will find some really heartbreaking descriptions of the folks on ventilators. For most, this is a Hail Mary attempt with only 50% survival rate. Many will have significant lung damage if they survive. We need more ventilators to be sure. But we desperately need to find ways to halt the progression of runaway lung inflammation that leads to needing a ventilator. Edit: this deve…

If this is true, the death toll of Covid-19 is going to be a lot worse than currently indicated, is that right? The complications of ventilators and whatever lasting damage is caused by the disease itself; will be killing a significant portion of the recovered population, will it not?

Most mortality estimates and forecasts include only deaths directly attributable to the virus. There are many indirect deaths that will be caused by it. Long term lung damage is one of the ways this will happen, probably among the most delayed. Many more deaths will happen because hospitals that are operating at capacity won't have the resources to prevent other deaths that they normally stop, or will have to stop non-critical treatments in ways that will reduce patients' life expectancies. I live in Madrid and know a neurologist that has stopped any intervention that can't be delayed.

Re: 'Pandemic ventilator' could offer solution in potential 'worst case' scenario

#100

Post by maxerickson »

mike_d wrote: post #76
bamboozled wrote: post #59

Earlier quoted context omitted.

I was going to say the same, there seems to be thread after thread about ventilators, but are they a golden ticket to good health ?

> but are they a golden ticket to good health No, building a ventilator is like building an engine because you need to go to the store - you're missing so much of the solution to the problem. I've also posted before [1] on why they are a terrible idea to waste time on "designing". That said, ventilators I believe are already a solved problem for COVID. We have tens of thousands in the strategic stockpile, and product…

For the US, the potential needs is in the millions and the current ventilator count is 100,000 (plus or minus tens of thousands).

I think we probably agree that industrial production is the way forward, but the numbers are not particularly comfortable.

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