One of the most interesting parts of this press release, following it on other boards, is the immediate "We already do that. Nothing new here."<p>That kind of reply would immediately lead me to think it was just a useless release, but then I see people posting comments along the lines of "No, we don't do that. In fact, we have a policy against doing that because of the danger of aerosolization"<p>For my hacker/systems wonks, this a great example of group learning happening world wide. I imagine there are many ICUs that do this, and many that forbid it. In such an environment, releases like this aren't submarines or spam; they're recurring prompts to administrators elsewhere that they might be missing something important.<p>I hate to sound cold, but damn this is an interesting example of how organizations learn. One commenter asked "I wonder how many of those hospitals who forbid intubation are doing it to patients with good insurance"<p>For the record, as far as I know this is a horrible thing to suggest. But the overall point, that large organizations have incentives that are many times removed from the actual work being done, is a good one.<p>This kind of conversation facilitation across borders is what the internet was supposed to be doing. I think this is the first time I've seen it working the way we had hoped. What's especially interesting to me is that many of the signals we look for in social forums, like "this is just a spam press release", "nothing new to see", or "there's some ulterior motivation here" voting up or down, etc., are actually counter-indicators and inhibitors of overall progress.
One of the most active figures in this debate has been a New York doctor named Cameron Kyle-Sidell. He frequently posts interesting sources on Twitter:<p><a href="https://twitter.com/cameronks" rel="nofollow">https://twitter.com/cameronks</a>
I don't doubt that this works well but there is a good reason that other hospitals are not using this approach. As the article mentions:<p>"This approach is not without risk, however. HFNCs blow air out, and convert the COVID-19 virus into a fine spray in the air. To protect themselves from the virus, staff must have proper personal protective equipment (PPE), negative pressure patient rooms, and anterooms, which are rooms in front of the patient rooms where staff can change in and out of their safety gear to avoid contaminating others."<p>"UChicago Medicine’s Emergency Department recently doubled its number of anterooms, thereby doubling its capacity to give ?high-flow nasal cannula to patients. The main hospital also added negative pressure rooms on two floors, making it safer and easier to take care of COVID-19 patients."<p>Not all hospitals have the ability to double the number of negative pressure rooms or even provide needed PPE to all caregivers.<p>A ventilator on the other hand allows for a HEPA filter in-line that prevents the spread of the disease within the hospital.
Related:<p>"The respiratory distress appears to include an important vascular insult that potentially mandates a different treatment approach than customarily applied for ARDS." <a href="https://twitter.com/jama_current/status/1253722428053823492" rel="nofollow">https://twitter.com/jama_current/status/1253722428053823492</a>
The article mentions 40% O2 sat to 80 or 90%; aren't the latter still really low? I'm certainly no doctor, but wikipedia[1] claims "Prolonged hypoxia induces neuronal cell death via apoptosis, resulting in a hypoxic brain injury" and suggests that 80-85% is considered <i>severe</i> and 86-90% moderate.<p>Granted, both are a hell of a lot better than 40%!<p>It adds, "Mild and moderate cerebral hypoxia generally has no impact beyond the episode of hypoxia; on the other hand, <i>the outcome of severe cerebral hypoxia will depend on the success of damage control, amount of brain tissue deprived of oxygen, and the speed with which oxygen was restored.</i>"<p>So I guess my questions are:<p>* How does this stack up against an intubated ventilator, assuming one is available?<p>* My understanding is the patients needing respiratory support are often on ventilation for 1-2 weeks; how much damage would one expect from having severe hypoxia for that duration?<p>[1]: <a href="https://en.wikipedia.org/wiki/Cerebral_hypoxia" rel="nofollow">https://en.wikipedia.org/wiki/Cerebral_hypoxia</a>
I wonder how they decide which patients would get the cannula instead of a ventilator?<p>Otherwise, intubation w/ a ventilator generally requires some form of sedation-- I wonder if that sedation has an impact on the body's ability to fight back.
Sounds like a promising strategy to manage patients, assuming the hospital has the necessary negative pressure rooms, etc. Especially since ventilators don’t even seem to be very effective. We’ve been seeing stories last few days that the large majority (88%) of folks put on ventilators in NYC, end up dying.
I'm an intensivist based in Sweden. From my perspective there is absolutely nothing new in this article. We have been using HFC for years if not decades.
With treatment so simple, we have effectively removed the healthcare system as a bottleneck on the rest of society.<p>I think we can safely reopen fully now and treat any serious cases using our existing healthcare systems in combination with this kind of new knowledge.<p>The longer we 'suppress the curve', when we are already far below hospital system capacity, the more economic and social damage we cause unnecessarily.