Debate about ventilators

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Swinglowandslow

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I dont bother reading things from the mailonline, just as I dont The Sun, Express, Mirror or Star. They are one and the same to me, so unless the publishing source is more trustworthy or official I treat them all the same.
No news is better than false news.
Closed mind!

Either these Drs exist or they don't. Either they work in their respective fields, which are what they say they are, or they don't.
And if they do, then what they say they experience is true or not.
If what they see is true, then
their suggested remedies may or may not be correct, but because of who they are they should be respected and looked at objectively.

But you don't want to acknowledge any of it?
 

hovis

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Closed mind!

Either these Drs exist or they don't. Either they work in their respective fields, which are what they say they are, or they don't.
And if they do, then what they say they experience is true or not.
If what they see is true, then
their suggested remedies may or may not be correct, but because of who they are they should be respected and looked at objectively.

But you don't want to acknowledge any of it?
i dont think he's dismissing the doctor. more the ways in which their statements get twisted or videos have an element of creative editing. the papers he has listed have form for this. I get your point though
 

huds1475

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I dont bother reading things from the mailonline, just as I dont The Sun, Express, Mirror or Star. They are one and the same to me, so unless the publishing source is more trustworthy or official I treat them all the same.
No news is better than false news.
I get your point about what sources you trust BM, But in this instance they are just reprinting a story that has been running in the ‘broadsheets‘ since early this week.
 

Bunkermagnet

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Closed mind!

Either these Drs exist or they don't. Either they work in their respective fields, which are what they say they are, or they don't.
And if they do, then what they say they experience is true or not.
If what they see is true, then
their suggested remedies may or may not be correct, but because of who they are they should be respected and looked at objectively.

But you don't want to acknowledge any of it?
Closed mind?...I don't think so.
I have read some interesting articles around this subject, but will not bother with publishers such as "mailonline" amd the ilk, that are only interested in click-bait.
Social media and the click bait merchants are awash with conspiracies, false news and misinformation why else were people burning down 5G masts?
Information from respected sources I will read and digest, but not from from places with "form".
For the record, I have used accupuncture and magnetic therapy for certain conditions which have worked, a closed mind wouldnt try them would they.
 

HomerJSimpson

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I've read a number of reports over the past week suggesting the same thing. i.e that the virus is causing oxygen depletion not pneumonia, and as a consequence, the ventilator is not the right treatment. Also a number of reports advocating the prone position to open up the airways instead of lying on their backs, which closes the airways down. The ICU consultant on the Ross Kemp documentary Thursday night said the same thing, that he'd used the prone position something like 10 times in the last 20 years, and 10 times in the last couple of weeks. The prone position is helping many patients improve and recover their oxygen levels very quickly after coming in with very low oxygen levels.
Not sure from what I've seen and been told that ventilators are making it worse and in a lot of our cases it has been essential treatment to take over their breathing to give them any chance of survival and other oxygen treatments weren't sufficient. We are also using proning.

I would suggest doctors are treating each case on its merits along with any associated co-morbidities and given the invasive nature of putting patients on a ventilator, the associated risks including further infections and difficulty weaning off the machines and the difficulty keeping the ventilators maintained and operational with missing stock and supplies, it isn't something done as the norm
 

Blue in Munich

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Closed mind?...I don't think so.
I have read some interesting articles around this subject, but will not bother with publishers such as "mailonline" amd the ilk, that are only interested in click-bait.
Social media and the click bait merchants are awash with conspiracies, false news and misinformation why else were people burning down 5G masts?
Information from respected sources I will read and digest, but not from from places with "form".
For the record, I have used accupuncture and magnetic therapy for certain conditions which have worked, a closed mind wouldnt try them would they.
Have you Googled Dr. Cameron Kyle-Sidell? The same guy in the Mailonline article has also been quoted in the New York Post & Time magazine, and a host of medical sites. I understand your distrust of certain sites, but to brush off what appears to be perfectly valid concerns about the current treatment programme because of who has chosen to publish it without apparently considering who has said it doesn't suggest an open mind.
 
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Hobbit

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The recognised treatment for extreme altitude sickness is ventilation, usually CPAP.

I originally had a post that ran to 7 paragraphs but it was way too technical.

Spare parts for ventilators; there are 3 types of spare parts. Service parts, repair parts, consumable parts.

Services are scheduled, and service parts won't be an issue.
Repairs aren't scheduled but regularly used repair parts are known, both the manufacturer and if its the onsite(hospital) team looking after the vent, know what they are and there is rarely any issue with repair parts.

Consumable parts. This will be similar to the PPE issue. The hoses to and from the patient are single use. There'll be a filter on the expired gas side, also single use and may be changed several times. There'll be a single use expiration valve and there'll be a flow meter that needs to be changed every time the patient is changed. 95%+ of consumable parts are cheap 3rd party parts, often from the same manufacturer/supplier that supplies a number of consumables, e.g. gowns/masks.
 

SocketRocket

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The more we learn about this virus the more worrying it becomes. Between this and the mounting evidence that recovering from covid-19 doesn't impart immunity it's not looking good.
I will see what the experts say and not what people are spreading on social media. I read again today that Oxford University suggest there is a very high chance they will have a vaccination available by September. Would you suggest their vaccine would be useless?
 

Bunkermagnet

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Have you Googled Dr. Cameron Kyle-Sidell? The same guy in the Mailonline article has also been quoted in the New York Post & Time magazine, and a host of medical sites. I understand your distrust of certain sites, but to brush off what appears to be perfectly valid concerns about the current treatment programme because of who has chosen to publish it without apparently considering who has said it doesn't suggest an open mind.
No, I haven't.
The thread title uses the word "debate"..... I gave miy views on the source and why I wouldnt take much notice because of that.
I don't mind what I'm called, it won't hurt or affect me:)
 

harpo_72

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I referenced this in the other covid thread.
Basically suggests that the blood is limited in its ability to transport oxygen.
 

SocketRocket

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That's the concern, yes, but the Oxford Uni scientists you reference are clearly better placed than me to understand the implications of reinfection rates reported from South Korea.

They're the experts and you and I are merely reading what's being reported and making ill-informed comments based on it to relieve our boredom.
I try my best to make informed comments. I asked you a question as I found your comment confusing.
 

ExRabbit

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I spoke to my best friend earlier tonight, who is a hospital doctor, and he said that the ventilator issue was a real thing which is being re-evaluated as new information comes in.
 
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Not sure from what I've seen and been told that ventilators are making it worse and in a lot of our cases it has been essential treatment to take over their breathing to give them any chance of survival and other oxygen treatments weren't sufficient. We are also using proning.

I would suggest doctors are treating each case on its merits along with any associated co-morbidities and given the invasive nature of putting patients on a ventilator, the associated risks including further infections and difficulty weaning off the machines and the difficulty keeping the ventilators maintained and operational with missing stock and supplies, it isn't something done as the norm
I didn’t mean to suggest that ventilators are of no use at all. of course there are many cases where they are. As experience with the virus develops, it seems that there are many cases where it may not be the appropriate treatment though. Of course each case is different, and handled differently based on the medics treating the patient. I am no medical doctor, I’m only joining the discussion like many of us, based on things we’ve been reading or hearing. The article linked at the start of this talks about the effects of covid being less like pneumonia and more like altitude sickness, which may not require a ventilator, or a ventilator may be the wrong treatment for that.

I appreciate a lot of media outlets have their own agendas, so have to be careful, but like I said above, I’ve read and heard that from a number of different places over the last week now. Mostly newspapers, I don’t recall if they all quoted the same source, I’m afraid I don’t have all the links, but when the consultant on Ross Kemp pretty much said the same thing about the oxygen treatment, it adds value to the theories for me. My wife is a nurse at MK General, the consultant in the Ross Kemp show has a very good reputation, he said it was something that he hadn't used much in nearly thirty years, but has used it as many times in the last few weeks. There has to be some credence in that.
 

Blue in Munich

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I referenced this in the other covid thread.
Basically suggests that the blood is limited in its ability to transport oxygen.
It suggests to me that the lung function is impaired to such a degree that the oxygen can't get into the blood, rather than the blood being limited in its ability to transport oxygen.

It also references Hobbit's point that CPAP is the usual treatment for altitude sickness rather than the type of ventilator being used.

The article also goes some way to explaining the YouTube video by a London doctor doing the rounds showing breathing exercises including face down prone breathing.

From the article;

But as hospital virus deaths climb, a Daily Mail investigation has found that the New York casualty doctor's unorthodox views, far from being crazy, might be the very opposite — and the key to preventing deaths. New York casualty doctor Cameron Kyle-Sidell has broken ranks with the medical establishment to warn ventilators are not being used in the right way
The death rate for those treated on ventilators is devastating. In one British study of 98 Covid-19 patients who were put on them or on similarly invasive breathing-support equipment, two-thirds died, according to a new report by our Intensive Care National Audit and Research Centre. In New York, which has been hit particularly hard by the virus, 80 per cent of ventilated patients failed to recover. The loss of life in other countries for those on the machines is equally terrifying. Dr David Farcy, the president of the American Academy of Emergency Medicine, warns against using them indiscriminately. His patients have been treated successfully with fastflow oxygen delivered through a simple nasal tube or mask. He also places patients on their left or right side, a process called proning that is simpler to perform on patients in masks than those on ventilators, which instantly raises oxygen levels in their blood.

'This has challenged everything we thought', he said. 'Six weeks ago everybody (in a hospital) would be running around getting ready to intubate you, put you on a machine'. But not any more. So why the change of tune? The answer is that some doctors have a remarkable new thesis: that the virus's symptoms are more akin to highaltitude breathing difficulties (caused by a lack of oxygen at extreme heights) or even carbon monoxide poisoning (which snuffs out oxygen in the body's red blood cells). In both instances, victims struggle for oxygen. But they do not have the ravaged lungs of pneumonia sufferers who are routinely put on ventilators. Dr Kyle-Sidell says of Covid-19 in his video: 'It appears to be some kind of viral-induced disease most resembling high-altitude sickness. 'It is as if tens of thousands of my fellow New Yorkers are flying on a plane at 30,000 ft and the cabin pressure is slowly being let out. These patients are slowly being starved of oxygen. 'The patients I am seeing are most like a person dropped off at the top of mount Everest without time to acclimatise. They look like patients on the brink of death (through lack of oxygen). They do not look like patients dying of pneumonia.'

For pneumonia cases, he explains, the ventilator 'does the work that patient's muscles can no longer do because they are too tired to do it'. But the muscles of Covid-19 patients are fine. 'They are suffering from oxygen failure, not respiratory failure.'

His supporters include distinguished medics such as Dr Luciano Gattinoni of Germany's Medical University of Gottingen. In a letter to the American Journal of Respiratory and Critical Care Medicine, Dr Gattinoni warns that the conventional use of ventilators may injure the lungs of Covid-19 victims. At one European hospital where virus patients were ventilated in this way, 60 per cent of them died. Into the fray, too, has stepped Professor Sherif Sultan, the Ireland-based President of the International Society of Vascular Surgery. He believes that invasive ventilation is not a solution for Covid-19 as it does not resemble pneumonia or a similar respiratory ailment. We need to stop treating patients for the wrong disease, he surmises in an analysis of medical research into the virus. Professor Sultan believes the vital clue that the coronavirus is different from pneumonia is in how it attacks the human body. It affects both lungs at the same time, which pneumonia rarely ever does.

One has to remember this is a very new disease, first seen in Western Europe just eight weeks ago, which doctors are desperately trying to understand. What baffles them is that many patients suffering from Covid-19 have extraordinarily low oxygen levels when they arrive at hospital. Mysteriously, they don't feel uncomfortable, they behave normally, and are in a state of what doctors have nicknamed 'happy' hypoxia (oxygen deprivation), then they suddenly deteriorate and collapse. Medical researchers in India report they can be laughing one minute and at death's door the next. And now, it seems, that rushing them to a ventilator may only make things worse. The machine takes over the breathing process of the patients who are heavily sedated so they cannot fight the sensation of not being able to breathe on their own. It pumps the lungs, but also sends oxygen to the vital organs, including the heart, brain and liver which need it to function.

Unlike pneumonia patients, kept on ventilators for a few days, Covid 19 sufferers are often left on them for weeks, even a month. One of the distinctive symptoms of Covid-19 is the way a yellowy mucous gunk clogs the millions of tiny air sacs lining the lungs. This means however hard the ventilator pushes oxygen into the lungs, that oxygen cannot get through the mucous barrier and into the body. This, in turn, causes the patient to become calamitously starved of oxygen. But if the medics try to fix the problem by turning up the pump volume, it leads to lung damage. Older patients who survive also risk permanent brain disorders from being heavily sedated for such a long period. This all helps explain why the death figures for ventilated virus cases remain so alarmingly high. Researchers in China's Wuhan (where Covid-19 first emerged) report that of 37 critically ill patients put on mechanical ventilators, 30 died within a month. In a U.S. study of patients in Seattle, only one of the seven patients older than 70 put on a ventilator survived. Of those under 70, just over a third made it. These are very poor odds. One person to analyse the tragically high fatality rates is Muriel Gillick, a geriatric and palliative care physician at Harvard Medical School in Massachusetts.

She said last week: 'Contrary to the impression that if extremely ill Covid-19 patients are treated with ventilators they will live, and if they are not they will die, it is not the reality.' She explains that the gummy yellow liquid in Covid-19 casualties 'limits oxygen transfer from the lungs to the blood' even when the machine is pumping. She added: 'Are we using ventilators in a way that makes sense for other diseases, but not for this one?' Scott Weingart, a critical care doctor in New York, agrees that ventilators are a 'knee jerk response'. He says: 'A high level of force, in a quest to restoring [the patient's] oxygen levels to normal, can damage the lungs. I would do everything in my power to avoid intubating [ventilating] patients'. More and more doctors now believe Covid-19 patients should get breathing masks which deliver oxygen in non-invasive way. A simple machine called CPAP, standing for Continuous Positive Airway Pressure, which is often used by people in their own homes to conquer sleep apnoea (snoring and interrupted breathing), can be an alternative to ventilators.

Dr Tom Lawton, an intensive care consultant at Bradford Royal Infirmary, has ordered 100 of the masks from a local Yorkshire manufacturer. His hospital was worried about getting enough ventilators in time to cope with the Covid-19 crisis. The masks keep the user's airways open. According to BBC Radio 4's The NHS Front Line, which has put out a diary from the hospital, they are a game changer.
One doctor told the programme, albeit cautiously: 'If we use these early enough during a patient's stay, we prevent people deteriorating and needing to go on more complex ventilators. We have been testing them . . . and there's evidence from China and the U.S. that they seem effective. They just help inflate the lungs and it seems to be beneficial.' This week, at its plant in Northamptonshire, car giant Mercedes has completed production of 10,000 CPAP breathing aids to fight Covid-19. Early results on 40 patients, who would otherwise have gone on to a ventilator, found half were able to go home within 14 days of admission to hospital. Today, around 40 to 50 per cent of patients with pneumonia or similar respiratory ailments die on ventilators. The reason for the dramatically higher rate among Covid-19 victims is not clear. The machines' supporters say it could be related to how sick they are when they're put on the machines. Others believe the outcome depends on the patients' physical shape before catching the virus. The truth may be simpler — that ventilators should not be used as they are currently being on Covid19 sufferers. Kyle-Sidell, the New York casualty doctor who recorded the YouTube video, says the machines are a tool in the medical armoury — but must be tuned to pump less aggressively and get more oxygen into patients. However, he remarks ruefully that the medical world will not easily change direction in this emergency: 'It is hard to switch tracks when the train is going a million miles an hour.' With thousands of lives at stake on this perilous journey, let us hope the shortcomings of ventilators are taken on board.
 

harpo_72

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Review the highwire video, but be warned Del Bigtree is anti vaccination and not seen as credible to certain medical sources.
However there are a number of medical papers referenced that talk about success using methods of oxygenation. It also highlights that an open mask oxygen system aerates the virus ( which I think was a major consideration for their use .. and very logical to be scared of!) They then discuss what they see in the blood and it being a virus that attacks the red blood cells .. that was the interesting direction.
They also discussed the way medicine is performed, in that it’s process and not diagnosis- the initial NY took a back or more pragmatic view in his second video. He was not dispelling the use of ventilators but to treat each case individually and use the appropriate action not a generic prescribed methodology ( time and human nature falls back to process its a safety net .. so it’s completely understandable that this is happening)

Not saying any of this is right or wrong (Not my area of expertise) just it is interesting and sad that we as a world cannot share and listen to one another ..! and it takes a Dr to release a video because no one is listening.
 

Hobbit

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CPAP versus an Intensive Care Ventilator. Where to start?

A Continuous Positive Airway Pressure(CPAP) pumps out a continuous flow of gas. Sometimes they are just a pump that pushes out room air, the sort used to combat sleep apnoea. Sometimes they have piped gas, allowing them to have the oxygen content dialled up - a hospital CPAP.

Why a continuous base pressure in the lungs? COVID sees a build up of (sticky) fluid in the lungs. It acts as a barrier to the oxygen AND it can also act as a glue, sticking the sides of the air sacks together potentially leading to a collapsed lung. Therefore, keep a base pressure in there with a dialled up O2 level and, all things being equal, it sorted.

Should we throw all the high end ventilators in the store cupboard till the end of the crisis? No, no and thrice no! Why not? Simply, for your most ill patients a high end ventilator can be set up as a very VERY sophisticated CPAP. It has levels of pressure support and control that your CPAP device just doesn't have. To use an analogy, what gets you around Silverstone quicker, a Ford Fiesta or a Ferrari? And as frightening as it might sound, you could switch on a CPAP and put a mask on a patient but you need the Lewis Hamilton of nursing to set up an ITU vent. An ITU nurse is just wow! Seriously, they are phenomenal.

If you put a chronically ill COVID patient on a basic CPAP they might still get better but they'll get better quicker on a sophisticated ITU vent set to CPAP.

But why do more patients die on ITU vents than on CPAP's? Because its your basket cases that are put on an ITU vent.
 
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