good young docs like this who actually think outside the box is what we need more of in this country....
In my day there were TWO ventilators in the US that could do “jet Ventilation”. They were incredibly expensive and by the time you had one flown in the patient was dead anyway. But what a Jet Vent can do is establish laminar flow to deliver oxygen without “breaths”. I sort of assumed all vents now days could do this, I don’t know. This technology allows you to ventilate a lung that is VERY stiff as well as lungs in a chest with a wide open hole in it. From what I have heard this disease produces a lung that is very “stiff”, the medical term is “non-compliant.” We heard on say they were requiring 15-25 cm of PEEP. That is astronomical and if your patient didn’t need a chest tube when you started that they dang well would soon. Because at 20 cm PEEP, during the inhalation phase you are seeing pressures that are MUCH higher. A jet vent can inflate a lung such that the PEEP pressure is the highest pressure it sees.
A report from the front line
—Hospital still empty
—Death rate of vented patient is NOT anywhere near 80%, at least in my institutions.
—Patient ARE being started on hydroxy and azithromycin at the confirmation of disease, not waiting until vent dependent
—I continue to see excellent results with hyrdoxy and Zithromax
—I am hopeful that we are turning the curve
—I have been doing a lot of work with telemedicine to relieve some in the hot zone, so I haven’t posted an analysis, will try to do so soon (foreshadow, data is holding)
—I am hearing more talk of perhaps getting the country reopened, I think April 30 we will start
—Peak net week in midatlantic (8 April NJ, 9 April NY) Lets see what happens
All in all, we will get through this, we will survive, and hopefully we will not freely give up our liberties.
Oh — Blood transfusions are universally bad — unless you really really need them. Lots of gold standard studies demonstrating restrictive transfusion practices are superior in terms of survival
HD — only for renal injury
Standard treatment of ARDS is what we are sort of good at. ECMO I have never been impressed with, but others may hav a different opinion.