[jfim]

Thanks for chiming in.

If I understand what you're saying correctly, you're saying that in the case where one would be so sick as to require a ventilator, they'd be in a situation where the ventilator only buys more time before the condition worsens, but doesn't actually address the root cause of the problem. As such, even if someone were to find a hospital-grade ventilator that fell off the back of a truck and managed to properly use it, the non-ventilator care is what makes the difference in outcome, not the ventilator itself.

Is that correct?

[prostheticvamp]

Not quite. The vent process itself requires careful management to provide net benefit (eg, controlling the level of sedation, avoiding secondary lung injury).

So while the non-vent care is what makes the difference, improper use of a hospital grade vent is more likely to do harm than good. Eg, Vents frequently clog. It requires a little bit of clinical experience to recognize that as what’s happening, and intervene appropriately. It’s not a complicated thing, and anyone that’s worked the ICU for a bit can recognize and handle it, but it would be a killer in the hands of a layman, and it’s only one out of a hundred issues.

Additionally, I’d hesitate to describe it as buying time, because that implies a linear sequence. Let’s say you have condition X that implies oxygenation and blood perfusion. Vent manages oxygenation while I work on maintaining perfusion and the underlying X, but if all I have is the vent, the patient will still die from lack of perfusion. The vent didn’t buy any additional time, it just closed off one route of death temporarily.

When a patient needs a vent, it’s very rare that the vent is the only route to death that is being proceeded along.

This was pretty stream of consciousness, but I’m typing in the bathroom, so ... sorry if it’s a bit of a mess.

[malandrew]

How do you maintain perfusion?

[prostheticvamp]

It depends on the precise mechanism of failure, but generally a combination of fluids of various concentrations and extravasation characteristics, and drugs that either cause the constriction of blood vessels, or increased heart pumping strength, or both (these often pop up in popular media as “pressors”).

[mike_d]

> a hospital-grade ventilator that fell off the back of a truck and managed to properly use it

Step 1 is inserting an ET tube in the patients mouth and down past the vocal cords without killing them in the process. So hope your truck also drops a laryngoscope.

Step 2 is picking the 6-7 parameters on the vent so you don't burst the lungs like an overfilled balloon or suffocate the patient because their throat is now sealed and you aren't providing enough O2. So steal a doctor from the truck too.

[catblast]

Theres all that and then the fact that the ventilator itself can make you sick. The number of patients (among hundreds) I have known on long term ventilator support that didn’t have a case of pneumonia in five years I can count on one finger.

Not to mention ventilators will damage your lungs if not correctly configured.