Ventilators

[LesPalenik]

Tesla demonstrated their ventilator prototype. It appears to be well designed and is much more complicated than one would think.
Interestingly, they were able to use many of the Tesla car parts - from the mechanical valves and hoses to the internal computer and the touch screen.

https://youtu.be/zZbDg24dfN0

[armand]

I guess they had too much time on their hands. Let's see working units out, they are not that close yet to a production model.
Oh, and those guys need to stop touching their masks.

[LesPalenik]

New reports suggest that the use of ventilators in many cases can be harmful.

Reuters interviewed 30 doctors and medical professionals in countries including China, Italy, Spain, Germany and the United States, who have experience of dealing with COVID-19 patients. Nearly all agreed that ventilators are vitally important and have helped save lives. At the same time, many highlighted the risks from using the most invasive types of them - mechanical ventilators - too early or too frequently, or from non-specialists using them without proper training in overwhelmed hospitals.

Many forms of ventilation use masks to help get oxygen into the lungs. Doctors’ main concern is around mechanical ventilation, which involves putting tubes into patients’ airways to pump air in, a process known as intubation. Patients are heavily sedated, to stop their respiratory muscles from fighting the machine.

Those with severe oxygen shortages, or hypoxia, have generally been intubated and hooked up to a ventilator for up to two to three weeks, with at best a fifty-fifty chance of surviving, according to doctors interviewed by Reuters and recent medical research. The picture is partial and evolving, but it suggests people with COVID-19 who have been intubated have had, at least in the early stages of the pandemic, a higher rate of death than other patients on ventilators who have conditions such as bacterial pneumonia or collapsed lungs.

A recent British study found two-thirds of COVID-19 patients put on mechanical ventilators ended up dying anyway, and a New York study found 88% of 320 mechanically ventilated COVID-19 patients had died.

“Initially we were intubating fairly quickly on these patients as they began to have more respiratory distress,” said Robert Hart, the hospital system’s chief medical officer. “Over time what we learned is trying not to do that.” Instead, Hart’s hospital tried other forms of ventilation using masks or thin nasal tubes, as Voshaar did with his German patient. “We seem to be seeing better results,” Hart said.

https://www.reuters.com/article/us-health-coronavirus-ventilators-specia/special-report-as-virus-advances-doctors-rethink-rush-to-ventilate-idUSKCN2251PE

[armand]

New reports suggest that the use of ventilators in many cases can be harmful.

https://www.reuters.com/article/us-health-coronavirus-ventilators-specia/special-report-as-virus-advances-doctors-rethink-rush-to-ventilate-idUSKCN2251PE

The jury is still out on what the best timing is for each intervention. You might try to wait but if the patient is crashing you have no choice, and then you are chasing the tail. Obviously intubating too early means some people who didn't need to go on a vent were intubated and with every intervention there are side effects.

Keep in mind, most of the times they don't die because they were intubated, but because they were too sick.

[armand]

Few quotes from the article

Reuters interviewed 30 doctors and medical professionals in countries including China, Italy, Spain, Germany and the United States, who have experience of dealing with COVID-19 patients. Nearly all agreed that ventilators are vitally important and have helped save lives. At the same time, many highlighted the risks from using the most invasive types of them - mechanical ventilators - too early or too frequently, or from non-specialists using them without proper training in overwhelmed hospitals.

This is not proof that ventilators have hastened death: The link between intubation and death rates needs further study, doctors say.

The doctors interviewed by Reuters agreed that mechanical ventilators are crucial life-saving devices, especially in severe cases when patients suddenly deteriorate.

Some doctors cautioned that the impression that the rush to ventilate is harmful may be partly due to the sheer numbers of patients in today’s pandemic.

People working in intensive care units know that the mortality rate of ARDS patients who are intubated is around 40%, said Thierry Fumeaux, head of an ICU in Nyon, Switzerland, and president of the Swiss Intensive Care Medicine Society. That is high, but may be acceptable in normal times, when there are three or four patients in a unit and one of them doesn’t make it.

“When you have 20 patients or more, this becomes very evident,” said Fumeaux. “So you have this feeling - and I’ve heard this a lot - that ventilation kills the patient.” That’s not the case, he said. “No, it’s not the ventilation that kills the patient, it’s the lung disease.”

Long-term ventilation management is complex, but Hill said some U.S. hospitals were trying to bring non-critical care physicians up to speed fast with webinars or even tip sheets. “That is a recipe for bad outcomes.”

“We intensivists don’t ventilate by protocol,” said Hill. “We may choose initial settings,” he said, “but we adjust those settings. It’s complicated.”

[LesPalenik]

That is a good, objective and very comprehensive article. Worthwhile to read in full.

[armand]

That is a good, objective and very comprehensive article. Worthwhile to read in full.

It's a good article but your interpretation that in many cases the ventilators can be harmful it's not entirely accurate, hence the quotes.

[JoeKitchen]

Tesla demonstrated their ventilator prototype. It appears to be well designed and is much more complicated than one would think.
Interestingly, they were able to use many of the Tesla car parts - from the mechanical valves and hoses to the internal computer and the touch screen.

https://youtu.be/zZbDg24dfN0

That could be the downfall; the more complicated the more likely it will break.  I remember watching  something on the first moon landing and NASA went out of their way  to use the least number of parts for everything just to keep failures at a minimum. 

[PeterAit]

That could be the downfall; the more complicated the more likely it will break.  I remember watching  something on the first moon landing and NASA went out of their way  to use the least number of parts for everything just to keep failures at a minimum.

Better to have a ventilator that might break than no ventilator at all.

[JoeKitchen]

Better to have a ventilator that might break than no ventilator at all.

Maybe, to a point though.  If you have a ventilator, you are putting a certain amount of confidence in it.  However, being over confident with a machine that his destine to break could create more problems then not having it at all, since you would be planning not to have one and thus taking other measures.  . 

Anyway, I read the fatality rate for those put on ventilators os 90%+?  It  does not seem to help very much.