This is good, and I'm glad they're doing it.<p>They've clearly got involvement with existing ventilator manufacturers.<p>Are they talking to doctors in ITUs? Here's a recent Facebook thread from people involved in London's new hospital: <a href="https://www.facebook.com/permalink.php?id=103930280957826&story_fbid=217689892915197" rel="nofollow">https://www.facebook.com/permalink.php?id=103930280957826&st...</a><p>It shows that ventilation of covid-19 patients is not like ventilation of other patients.<p>I'll paste part of it here because I know some can't visit Facebook.<p>It's by Daniel Martin OBE, Macintosh Professor of Anaesthesia, Intensive Care Lead for High Consequence Infectious Diseases.<p>---everything below this point is a direct quote from Daniel Martin---<p>Ventilation<p>- Early high PEEP is probably not the right strategy and may be harmful. This is not ARDS in the early phase of the illness.<p>- Avoid spontaneous ventilation early in ICU admission as also may be harmful.<p>- There is clear microvascular thrombosis happening in the pulmonary circulation, which leads to an increased dead space.<p>- Also some evidence of early pulmonary fibrosis reported from Italy, possibly oxygen related, possibly inflammation related.<p>- Not many patients have reached extubation yet in London, re-intubation seems to be common. I highlighted our experiences of airway swelling / stridor / reintubation.<p>- Brompton are seeing wedge infarcts in the lungs on imaging, along with pulmonary thrombosis without DVT.<p>- Proning is essential and should be done early. Don’t just do it once. Threshold for many centres is a PF ratio of 13, but all agreed, do it even earlier.<p>- Early on in the disease, the benefit of proning lasts < 4 hours when turned back to supine, as the disease progresses into a more ARDS type picture, the effect is more long lasting.<p>- Many centres using inhaled nitric oxide and prostacyclin with good effect. Tachyphylaxis with NO after 4-5 days.<p>- Generally people are using humidified circuits with HMEs.<p>- A very interesting thing they are doing at Georges is cohorting by phase of disease i.e. early, late, extubation / trachy. It involves more moving of patients but helps each team to focus on things more easily.<p>- Leak test before extubation is crucial, others are also seeing airway swelling.<p>- Wait longer than usual before extubating, high reintubation rates reported. Do not extubatne if inflam markers still high.<p>My conclusions from this are:<p>- Less aggressive PEEP strategy at the beginning of the disease and go straight for proning.<p>- Thromboembolic disease is prevalent, look for it. No one is sure about whether we should anti-coagulate everyone, this is probably too risky.<p>- An extubation protocol is needed immediately.<p>- We should consider using inhaled prostacyclin again (like we previously did) as it seems to be working early in the disease.