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Started By
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re: Treatment shifting away from intubation and towards CPAP?
Posted on 4/3/20 at 10:11 am to the808bass
Posted on 4/3/20 at 10:11 am to the808bass
quote:
It’s becoming painfully clear that once a patient is vented, it’s very difficult to wean them.
That's how ARDS has always been.
1
Posted on 4/3/20 at 10:11 am to deeprig9
Yeah. I saw some discussion that once patients hit 6L, they’re going on a vent. But I think they were applying normal vent probabilities to those decisions (and some doctors still are). That may be changing with the low survivability of vent patients.
Posted on 4/3/20 at 10:15 am to MichiganTiger
The article kind of contradicts itself. It implies that lung compliance is not the issue yet they say 18 cm H2O is the level of CPAP. You should always avoid intubation and Ventilation if possible. Spontaneously breathing with 18 of CPAP is pretty tough to do even for alveolar recruitment. Once an alveolus collapses though, you have to overcome a whole lot of surface tension to Re-aerate it. Think of a balloon. Hard to get it open but once it’s open, it becomes way easier to inflate. That website is hard to navigate so I might have missed something.
BiPAP in also non invasive and they sort compared the two but I’m not sure their conclusion.
BiPAP in also non invasive and they sort compared the two but I’m not sure their conclusion.
Posted on 4/3/20 at 10:17 am to Stingray
Sure. There’s a big difference between 40-45% mortality and 90%, though.
Posted on 4/3/20 at 10:17 am to MichiganTiger
First, if you find yourself in a COVID unit lay on your stomach and cough that shite out, you may think it is a dry cough but it isn't. Do everything you can to avoid a vent, vents are the current DNR without signing a DNR.
Second, CPAP shows promise BUT most hospitals do not have filtered CPAP machines in inventory. The problem with the non-filtered ones (like most people that use them at home have) is they can aerosolize the virus and significantly increase the chances of health care workers being infected.
Second, CPAP shows promise BUT most hospitals do not have filtered CPAP machines in inventory. The problem with the non-filtered ones (like most people that use them at home have) is they can aerosolize the virus and significantly increase the chances of health care workers being infected.
Posted on 4/3/20 at 10:18 am to GeauxFightingTigers1
quote:
More vents isn't going to help, keeping people out of the hospital will i.e. self-isolate the elderly with pre-existing conditions.
Posted on 4/3/20 at 10:19 am to Chromdome35
quote:And their population has the highest percentage of ACE-2 cells, which would make them most susceptible to the WuFlu.
China needs to face up to their lies and deceit on this. They let the rest of the world get slammed while they went about covering it up.
They're cooking the books for sure.
Posted on 4/3/20 at 10:22 am to Ace Midnight
quote:
"Mr. President, can you guarantee that every person who needs a CPAP machine can get one?"
"Mr. President, why did you order GM to produce all those ventilators when dying patients really need CPAP machines?"
"Mr. President, why weren't you prepared to supply CPAP to save dying americans?"
"Mr. President, doctors say they need CPAP machines not ventillators, why don't you believe in science?"
Then Tooty will dutifly be here saying "Americans are dying solely because Donald Trump didn't order CPAP machines".
Posted on 4/3/20 at 10:22 am to MichiganTiger
quote:I would hope avoiding intubation/ventilation where possible would be protocol nearly anywhere.
Treatment shifting away from intubation and towards CPAP?
But that is their emphasis, more so than actual "shifting away" from mechanical ventilation. Their point is, especially in younger healthier patients, there is an extended tolerance to levels of pulmonary insufficiency. Those are instances where CPAP should be attempted.
Posted on 4/3/20 at 10:23 am to MichiganTiger
Great. Now we will be hearing about critical shortages of CPAPs as well as ventilators.
Posted on 4/3/20 at 10:24 am to El Segundo Guy
quote:
My wife is busting her butt. Not the Facebook meme nurse shite either. Trust me, if any of you baws get the China flu, you'd want my wife as your nurse.
Posted on 4/3/20 at 10:27 am to CaptSpaulding
And the media is so worried about their profits from China that they're now doing the Chinese' governments dirty work. They are in a campaign blitz to shame anyone who calls it the "Chinese Coronavirus" or "Wuhan Virus".
frick these lying arse traitors.
frick these lying arse traitors.
Posted on 4/3/20 at 10:31 am to Chromdome35
quote:
Edited to add: China needs to face up to their lies and deceit on this. They let the rest of the world get slammed while they went about covering it up
When all said and done, nothing will happen to them and our politicians will still try and blame each other.
We are too stupid to learn any real lesson from this.
Posted on 4/3/20 at 10:37 am to MetrySaint24
quote:
Good friend of mine is doing a lot of intubating and he says at his hospital once you go on the vent it's been around a 95% death sentence. Not saying that's how it will play out nationally but that's been his experience.
What hospital are they at? If they are treating the elderly/already sick then sure, but theres other people saying 50% come off the vent just fine.
ETA: just confused disregard
This post was edited on 4/3/20 at 11:17 am
Posted on 4/3/20 at 10:49 am to MichiganTiger
quote:
Current thinking is that early intubation should be avoided. This panel leans towards CPAP. So...bottom line, it appears better for the patients...and we may be able to put off demands for more vents.
you can pry my resmed from my cold dead fingers
Posted on 4/3/20 at 10:53 am to kengel2
quote:
saying 50% come off the vent just fine.
Not with the Rona.
Posted on 4/3/20 at 10:55 am to Chromdome35
quote:
Edited to add: China needs to be bombed into the stone age for their lies and deceit on this. They let the rest of the world get slammed while they went about covering it up.
FIFY
Posted on 4/3/20 at 11:00 am to deeprig9
quote:
they are tubing people who would otherwise just need a mask or PAP of some sort, but the PAP's aerosolize the virus and make it spread throughout the hostpital so they are tubing anyone that needs O2,
Ordinarily, I would go to a Bipap as first line for lower airway disease but yeah...they’re saying not to use NIPPV or nebulizers for this reason.
Posted on 4/3/20 at 11:01 am to MichiganTiger
Great! Tesla is making CPAP machines.
Posted on 4/3/20 at 11:02 am to the808bass
quote:
Not with the Rona.
Yup, I was confused, I wasnt thinking of a ventilator. I was thinking of some other thing.
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