Intubated ventilator in Coronavirus patients. Soultion or problem. Why not to use unintubated?

[Anonymous]

Do we all know what does it take to wean the person of a ventilator? Germans did some studies..


CONCLUSIONS:
Weaning was successful in two thirds of patients who had been on prolonged mechanical ventilation and had then been transferred to weaning facilities staffed by chest physicians. These centres effectively improved the quality of care of patients on prolonged mechanical ventilation by avoiding long-term invasive ventilation and sparing cost-intensive ICU resources. The problems that still exist may be overcome by a network of weaning facilities.

the full text:
[Weaning from mechanical ventilation. A survey of the situation in pneumologic respiratory facilities in Germany].
https://www.ncbi.nlm.nih.gov/pubmed/18363187

[Anonymous]

Anonymous wrote:

Anonymous wrote:Conquer correct spelling and clear writing.

And then come back here to conquer respiration technology.

It might be too late for me to conquer that much but it is never to late for you to work on kindness! Dude.

I love how people try to weaponize “kindness”.

PP is right.
OP’s post makes no sense. AND it’s riddled with errors.
The people making decisions about how to do respiration best are experts.
Would you trust OP’s views on respirators?

Please. If you want to be taken seriously on a scientific subject, please show that you are expert enough to at minimum write coherently and evaluate scientific sources.

[Anonymous]

Yes, being on a ventilator is really bad. But it's not done on a whim, generally the alternative is worse.

[Anonymous]

Anonymous wrote:The videos from Italian hospitals showed many people with clear balloon type equipment over their heads. it was some form of non intubated pressurized ventilation. I have never seen those here but maybe we have them?

We don't, they are not FDA approved here, although we do have other forms of NIV that can be used for patients who are not the most severe. But it he most severe situations, there needs to be more precise control of pressures and of the airway than either a helmet or a mask can provide, so they need to intubate.

[Anonymous]

Anonymous wrote:Do we all know what does it take to wean the person of a ventilator? Germans did some studies..


CONCLUSIONS:
Weaning was successful in two thirds of patients who had been on prolonged mechanical ventilation and had then been transferred to weaning facilities staffed by chest physicians. These centres effectively improved the quality of care of patients on prolonged mechanical ventilation by avoiding long-term invasive ventilation and sparing cost-intensive ICU resources. The problems that still exist may be overcome by a network of weaning facilities.

the full text:
[Weaning from mechanical ventilation. A survey of the situation in pneumologic respiratory facilities in Germany].
https://www.ncbi.nlm.nih.gov/pubmed/18363187

There are many studies, not just a few and not just from Germany, about how to wean patients from ventilators. Having patients in ARDS on ventilators, and needing to make plans to wean them is not a new thing. What's new with COVID is the numbers.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The videos from Italian hospitals showed many people with clear balloon type equipment over their heads. it was some form of non intubated pressurized ventilation. I have never seen those here but maybe we have them?

We don't, they are not FDA approved here, although we do have other forms of NIV that can be used for patients who are not the most severe. But it he most severe situations, there needs to be more precise control of pressures and of the airway than either a helmet or a mask can provide, so they need to intubate.

Interesting, thanks. They seemed to be using them for cases that needed more than oxygen or a mask but less than a ventilator. Do we have noninvasive mechanical options similar to the helmet?

[Anonymous]

Anonymous wrote:I am going with doctors tried everything and what you are suggesting led to death.

Not my idea really.. It might not be right fit for everyone but perhaps for some?


US National Library of Medicine
National Institutes of Health

Non-invasive respiratory support
If the patient remains hypoxaemic on high flow oxygen (15 l/min) continuous positive airways pressure (CPAP) may be used. The technique improves oxygenation by recruiting underventilated alveoli and so is most successful in clinical situations where alveoli are readily recruited, such as acute pulmonary oedema and postoperative atelectasis. It is also helpful in immunocompromised patients with pneumonia. As intubation is avoided the risks of nosocomial pneumonia are reduced.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116024/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The videos from Italian hospitals showed many people with clear balloon type equipment over their heads. it was some form of non intubated pressurized ventilation. I have never seen those here but maybe we have them?

We don't, they are not FDA approved here, although we do have other forms of NIV that can be used for patients who are not the most severe. But it he most severe situations, there needs to be more precise control of pressures and of the airway than either a helmet or a mask can provide, so they need to intubate.

Interesting, thanks. They seemed to be using them for cases that needed more than oxygen or a mask but less than a ventilator. Do we have noninvasive mechanical options similar to the helmet?

In the US NIV (non invasive ventilation) is generally delivered with a mask. But it's different from someone who is just getting oxygen through a mask. It works basically the same way as the helmet, by increasing the pressure from the outside. It works for some patients and not for others. It is being widely used with COVID patients, but the sickest patients still need to be intubated.

One issue with NIV is that many of the masks that are in use are vented, which exposes everyone in the room to aerosolized lung contents. If you read the recent article about hospitals repurposing scuba masks, they are using them for NIV, when they have run out of masks that aren't vented.

[Anonymous]

No one is ventilated for funsies. It is frequently a last ditch effort to save someone who will otherwise die.

Are you kidding me with the percentages of negative outcomes? You know what’s a certain thing? That if these patients weren’t ventilated, they would die. So you go ahead and tell the doctor “no, thanks- that’s dangerous” when it’s your turn; the next guy will be thankful to be given a chance.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The videos from Italian hospitals showed many people with clear balloon type equipment over their heads. it was some form of non intubated pressurized ventilation. I have never seen those here but maybe we have them?

We don't, they are not FDA approved here, although we do have other forms of NIV that can be used for patients who are not the most severe. But it he most severe situations, there needs to be more precise control of pressures and of the airway than either a helmet or a mask can provide, so they need to intubate.

Interesting, thanks. They seemed to be using them for cases that needed more than oxygen or a mask but less than a ventilator. Do we have noninvasive mechanical options similar to the helmet?

In the US NIV (non invasive ventilation) is generally delivered with a mask. But it's different from someone who is just getting oxygen through a mask. It works basically the same way as the helmet, by increasing the pressure from the outside. It works for some patients and not for others. It is being widely used with COVID patients, but the sickest patients still need to be intubated.

One issue with NIV is that many of the masks that are in use are vented, which exposes everyone in the room to aerosolized lung contents. If you read the recent article about hospitals repurposing scuba masks, they are using them for NIV, when they have run out of masks that aren't vented.

I heard they are using CPAP machines and ASV machines. Is CPAP similar what you are describing with the pressurized mask? The helmets seem to reduce the vented aspect - why are they not approved here?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I am going with doctors tried everything and what you are suggesting led to death.

Not my idea really.. It might not be right fit for everyone but perhaps for some?


US National Library of Medicine
National Institutes of Health[/b]

Non-invasive respiratory support
If the patient remains hypoxaemic on high flow oxygen (15 l/min) continuous positive airways pressure (CPAP) may be used. The technique improves oxygenation by recruiting underventilated alveoli and so is most successful in clinical situations where alveoli are readily recruited, such as acute pulmonary oedema and postoperative atelectasis. It is also helpful in immunocompromised patients with pneumonia. As intubation is avoided the risks of nosocomial pneumonia are reduced.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116024/

This is not a study from NIH. From the article you cited:

Maire P Shelly is consultant in anaesthesia and intensive care and Peter Nightingale is director of intensive care, Withington Hospital, Manchester.

NIH just runs the search service.

The US desperately needs to start teaching in schools how to read the scientific literature and figure out what’s trustworthy and what’s not.
(Also, start teaching civics in schools again, restoring what Reagan rolled back. But that’s a different story.)

[Anonymous]

This thread really brings that tweet full circle.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The videos from Italian hospitals showed many people with clear balloon type equipment over their heads. it was some form of non intubated pressurized ventilation. I have never seen those here but maybe we have them?

We don't, they are not FDA approved here, although we do have other forms of NIV that can be used for patients who are not the most severe. But it he most severe situations, there needs to be more precise control of pressures and of the airway than either a helmet or a mask can provide, so they need to intubate.

Interesting, thanks. They seemed to be using them for cases that needed more than oxygen or a mask but less than a ventilator. Do we have noninvasive mechanical options similar to the helmet?

In the US NIV (non invasive ventilation) is generally delivered with a mask. But it's different from someone who is just getting oxygen through a mask. It works basically the same way as the helmet, by increasing the pressure from the outside. It works for some patients and not for others. It is being widely used with COVID patients, but the sickest patients still need to be intubated.

One issue with NIV is that many of the masks that are in use are vented, which exposes everyone in the room to aerosolized lung contents. If you read the recent article about hospitals repurposing scuba masks, they are using them for NIV, when they have run out of masks that aren't vented.

I heard they are using CPAP machines and ASV machines. Is CPAP similar what you are describing with the pressurized mask? The helmets seem to reduce the vented aspect - why are they not approved here?

You don't know how CPAP works, and you are weighing in on having solved the damage from intubated ventilation but using an alternative .. but you don't know how it works, just that you must be right about it?

What on earth?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The videos from Italian hospitals showed many people with clear balloon type equipment over their heads. it was some form of non intubated pressurized ventilation. I have never seen those here but maybe we have them?

We don't, they are not FDA approved here, although we do have other forms of NIV that can be used for patients who are not the most severe. But it he most severe situations, there needs to be more precise control of pressures and of the airway than either a helmet or a mask can provide, so they need to intubate.

Interesting, thanks. They seemed to be using them for cases that needed more than oxygen or a mask but less than a ventilator. Do we have noninvasive mechanical options similar to the helmet?

I LOVE the idea, maybe we can have the FDA approve them here. so much cheaper and easier so it seems then a machine. Who knows.. lots of red tape went, so maybe this can get approved too.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The videos from Italian hospitals showed many people with clear balloon type equipment over their heads. it was some form of non intubated pressurized ventilation. I have never seen those here but maybe we have them?

We don't, they are not FDA approved here, although we do have other forms of NIV that can be used for patients who are not the most severe. But it he most severe situations, there needs to be more precise control of pressures and of the airway than either a helmet or a mask can provide, so they need to intubate.

Interesting, thanks. They seemed to be using them for cases that needed more than oxygen or a mask but less than a ventilator. Do we have noninvasive mechanical options similar to the helmet?

Is this what you were talking about?