80% of NYC's coronavirus patients who are put on ventilators

[bitrex]

On 4/10/2020 5:17 PM, Jeff Liebermann wrote:

On Fri, 10 Apr 2020 12:00:26 -0700 (PDT), George Herold
ggherold@gmail.com> wrote:

OK, That checks the 'why are face masks good?' box. I went food shopping
with my bandanna on yesterday. ~20% of people had some sort of mask on.
Here's a million dollar idea. Trump bandanna's! "Make America Safe Again"
George H.

Done. Here's me modeling my red Republican bandana:
http://www.learnbydestroying.com/jeffl/pics/jeffl/slides/cloth%20PPE.html
I also have a matching blue bandana for when it's expedient to act
like Democrat.

Make America Late.

I don't think that guy I see with the plug-in Prius with the NRA sticker
on it is fooling anyone.

 

[Jeff Liebermann]

On Fri, 10 Apr 2020 17:34:59 -0400, bitrex <user@example.net> wrote:

On 4/10/2020 5:17 PM, Jeff Liebermann wrote:
On Fri, 10 Apr 2020 12:00:26 -0700 (PDT), George Herold
ggherold@gmail.com> wrote:

OK, That checks the 'why are face masks good?' box. I went food shopping
with my bandanna on yesterday. ~20% of people had some sort of mask on.
Here's a million dollar idea. Trump bandanna's! "Make America Safe Again"
George H.

Done. Here's me modeling my red Republican bandana:
http://www.learnbydestroying.com/jeffl/pics/jeffl/slides/cloth%20PPE.html
I also have a matching blue bandana for when it's expedient to act
like Democrat.

Make America Late.

Oops. That should be "Make America Late Again".

I don't think that guy I see with the plug-in Prius with the NRA sticker
on it is fooling anyone.

In my case, it's simply a matter of selling my vote to the highest
bidder. For what little it's worth, I'm a registered Republican and
am not a member of the NRA. From 1952 to 1992, California was a
Republican state (except for 1964):
<https://en.wikipedia.org/wiki/Politics_of_California#Political_parties>
My parents were European immigrants, who are traditionally Democrats.
To piss them off, I registered Republican. It didn't seem to matter
much to which party I was registered. California has done it's best
to attract cheap labor, most of which have stayed. These tend to
register Democrat, resulting in a switch to California becoming a
Democrat state.
"The immigration of Hispanic Americans and Asian Americans
and migration of northern liberals, who tend to vote Democratic,
and the flight of white, middle and upper-middle class suburbanites
out of the state shifted the balance in favor of the Democratic
Party."
I guess I should follow the herd and switch my registration to
Democrat. However, I'm lazy, will probably remain Republican for now,
am awaiting for a suitable bribe to insure my loyalty, and have no
interest in purchasing a Prius. Meanwhile, I'll wear whichever color
bandana is appropriate for which way the wind blows.



--
Jeff Liebermann jeffl@cruzio.com
150 Felker St #D http://www.LearnByDestroying.com
Santa Cruz CA 95060 http://802.11junk.com
Skype: JeffLiebermann AE6KS 831-336-2558

 

[Lasse Langwadt Christense]

fredag den 10. april 2020 kl. 23.30.26 UTC+2 skrev Jeff Liebermann:

On Fri, 10 Apr 2020 14:19:41 -0700 (PDT), Lasse Langwadt Christensen
langwadt@fonz.dk> wrote:

so they should use an ECMO machine instead?

"FDA Approves ECMO to Treat COVID-19 Patients"
https://www.dicardiology.com/article/fda-approves-ecmo-treat-covid-19-patients

Personally, I don't think it's going to work. With the entire surface
area of the lungs infected and inflamed, an ECMO machine might keep
the patient alive for a while. Eventually, they will need to go back
to normal breathing. If the aveoli recover sufficiently, then it's
possible. However, if it's like what I've been reading about
"recovered" patients having permanent fibrosis (scaring) of the lungs,
the patient will not be unable to breath normally.

The idea would be to keep people alive long enough to get over the virus
without destroying their lungs in the process

A bit of googling does turn some trials of using ECMO instead of ventilation
for Acute Respiratory Distress Syndrome that seems to indicate that it might
be safer

 

Jeff Liebermann <jeffl@cruzio.com> wrote in
news:b5o19fh712fos9da3clek1ccgpflftga7j@4ax.com:

On Fri, 10 Apr 2020 12:00:26 -0700 (PDT), George Herold
ggherold@gmail.com> wrote:

OK, That checks the 'why are face masks good?' box. I went food
shopping with my bandanna on yesterday. ~20% of people had some
sort of mask on. Here's a million dollar idea. Trump bandanna's!
"Make America Safe Again" George H.

Done. Here's me modeling my red Republican bandana:
http://www.learnbydestroying.com/jeffl/pics/jeffl/slides/cloth%20P
PE.html> I also have a matching blue bandana for when it's
expedient to act like Democrat.

Make America Late.

Except Trump wants it to say "Spike up your death numbers with a
nice re-infection BANG party". Come back with a bang.

He wants to show that America is stupid... AGAIN.

 

[Flyguy]

On Thursday, April 9, 2020 at 5:16:57 PM UTC-7, bloggs.fre...@gmail.com wrote:

Dr. Tiffany Osborn, a critical-care specialist at the Washington University School of Medicine, told NPR on April 1 that ventilators could actually damage a patient's lungs.

"The ventilator itself can do damage to the lung tissue based on how much pressure is required to help oxygen get processed by the lungs," she said.


"We know that mechanical ventilation is not benign," Dr. Eddy Fan, an expert on respiratory treatment at Toronto General Hospital, told the AP.

"One of the most important findings in the last few decades is that medical ventilation can worsen lung injury — so we have to be careful how we use it."


Dr. Joseph Habboushe, an emergency-medicine doctor in Manhattan, told the AP that until a few weeks ago, it was routine in the city to place particularly ill coronavirus patients on ventilators. Now doctors are increasingly trying other treatments.

"If we're able to make them better without intubating them," Habboushe said, "they are more likely to have a better outcome — we think."


Dr. Howard Zucker, the New York state health commissioner, said on Wednesday that officials were examining other treatments to use before ventilation but that it was "all experimental," the AP reported.

https://www.businessinsider.com/coronavirus-ventilators-some-doctors-try-reduce-use-new-york-death-rate-2020-4

Spending another gazillion bucks on something that's a death machine, and the people who survive it have seriously damaged lungs.

This is an even bigger fiasco than the chloroquine which is killing people with cardiac arrhythmia, another treatment doctors are becoming wary of.

I didn't know you are a cardiologist.

 

[speff]

On Friday, 10 April 2020 17:55:11 UTC-4, Lasse Langwadt Christensen wrote:

fredag den 10. april 2020 kl. 23.30.26 UTC+2 skrev Jeff Liebermann:
On Fri, 10 Apr 2020 14:19:41 -0700 (PDT), Lasse Langwadt Christensen
langwadt@fonz.dk> wrote:

so they should use an ECMO machine instead?

"FDA Approves ECMO to Treat COVID-19 Patients"
https://www.dicardiology.com/article/fda-approves-ecmo-treat-covid-19-patients

Personally, I don't think it's going to work. With the entire surface
area of the lungs infected and inflamed, an ECMO machine might keep
the patient alive for a while. Eventually, they will need to go back
to normal breathing. If the aveoli recover sufficiently, then it's
possible. However, if it's like what I've been reading about
"recovered" patients having permanent fibrosis (scaring) of the lungs,
the patient will not be unable to breath normally.

The idea would be to keep people alive long enough to get over the virus
without destroying their lungs in the process

A bit of googling does turn some trials of using ECMO instead of ventilation
for Acute Respiratory Distress Syndrome that seems to indicate that it might
be safer

It's in the recommended treatment protocol from the Chinese experience:

X. ECMO Support for COVID-19 PatientsCOVID-19 is a novel, highly infectious disease primarily targeting pulmonary alveoli, which damages primarily the lungs of critically ill patients and leads to severe respiratory failure. For the application of extracorporeal membrane oxygenation (ECMO) in COVID-19 treatment, medical professionals need to pay close attention to the following: the time and means of intervention, anticoagulant and bleeding, coordination with mechanical ventilation, awake ECMO and the early rehabilitation training, strategy of handling for complications.ECMO Intervention Timing1.1 Salvage ECMOIn the state of mechanical ventilation support, measures such as lung protective ventilation strategy and prone position ventilation have been taken for 72 h. With the onset of one of the following conditions, salvage ECMO intervention needs to be consid-ered. (1) PaO2/FiO2 < 80 mmHg (regardless of what the PEEP level is);1(2) Pplat ≤ 30 mmHg, PaCO2 > 55 mmHg; (3) The onset of pneumothorax, air leakage > 1/3 tidal volume, duration > 48 h; (4) Circulation deterioration, the dosage of norepinephrine > 1 μg/(kg×min); (5) Cardio-pulmonary resuscitation in vitro life support ECPR.1.2 Replacement ECMOWhen the patient is not suitable for long-term mechanical ventilation support, i.e., the patient is not able to obtain the expected results, ECMO replacement needs to be adopt-ed immediately. With the onset of one of the following conditions, ECMO replacement needs to be considered. (1) Decreased lung compliance. After the pulmonary recruitment maneuver, the compli-ance of the respiratory system < 10 mL/cmH2O;(2) Persistent exacerbation of pneumomediastinum or subcutaneous emphysema. And the parameters of mechanical ventilation support cannot be reduced within 48 h, according to the estimation;(3) PaO2/FiO2 < 100 mmHg. And it cannot be improved by routine methods in 72 h.1.3 Early Awake ECMOEarly awake ECMO can be applied to patients who have been supported by mechanical ventilation with the expected high parameters for more than 7 days and who meet the necessary conditions of awake ECMO. They might benefit from it. All the following conditions must be met: (1) The patient is in a clear state of consciousness and is fully compliant. He or she understands how ECMO works and its maintenance requirements;(2) The patient is not complicated with neuromuscular diseases;(3) Pulmonary damage score Murry > 2.5;(4) Few pulmonary secretions. The time interval between the two airway suction procedures > 4 h;(5) Stable hemodynamics. Vasoactive agents are not required for assistance.

 

[Tom Del Rosso]

Lasse Langwadt Christensen wrote:

so they should use an ECMO machine instead?

How are they different from "heart-lung" machines? Searching says they
are similar but not the same.

 

[Ricky C]

On Sunday, April 12, 2020 at 9:00:44 PM UTC-4, Tom Del Rosso wrote:

Jeff Liebermann wrote:
On Thu, 9 Apr 2020 17:16:52 -0700 (PDT),
bloggs.fredbloggs.fred@gmail.com wrote:

"The ventilator itself can do damage to the lung tissue based
on how much pressure is required to help oxygen get
processed by the lungs," she said.

Here's a video on the design requirements for a proper ventilator
which includes some comments on over-pressure and breathing
synchronization problems:

"A Guide To Designing Low-Cost Ventilators for COVID-19"
https://youtu.be/7vLPefHYWpY

A polio-era iron lung is big, but simple, and aids breathing with
negative pressure. Maybe we should make those in garages instead.

An iron lung is a solution to a different problem. I think this has been discussed before. With polio the problem is paralysis of the muscles that create the vacuum inside the chest drawing air into the lungs. So an iron lung creates the partial vacuum outside the chest to aid the muscles that aren't working well or at all.

With pneumonia the problem is fluid and congestion inside the lung while the chest muscles and diaphragm work just fine. Pulling a partial pressure outside the chest will provide insufficient or no aid at all. Forcing air into the lung with positive pressure can help.

Different problems, different solutions.

--

Rick C.

- Get 1,000 miles of free Supercharging
- Tesla referral code - https://ts.la/richard11209

 

[Tom Del Rosso]

Jeff Liebermann wrote:

On Thu, 9 Apr 2020 17:16:52 -0700 (PDT),
bloggs.fredbloggs.fred@gmail.com wrote:

"The ventilator itself can do damage to the lung tissue based
on how much pressure is required to help oxygen get
processed by the lungs," she said.

Here's a video on the design requirements for a proper ventilator
which includes some comments on over-pressure and breathing
synchronization problems:

"A Guide To Designing Low-Cost Ventilators for COVID-19"
https://youtu.be/7vLPefHYWpY

A polio-era iron lung is big, but simple, and aids breathing with
negative pressure. Maybe we should make those in garages instead.

 

[Lasse Langwadt Christense]

søndag den 12. april 2020 kl. 22.42.38 UTC+2 skrev Tom Del Rosso:

Lasse Langwadt Christensen wrote:

so they should use an ECMO machine instead?

How are they different from "heart-lung" machines? Searching says they
are similar but not the same.

As I understand it a "heart-lung" machine basically replaces the whole
heart and lung system. And an ECMO more of a system in "in parallel"
with the lungs helping to oxygenate the blood