Name:	Talullahhound -	Reply
Subject:	Thoughts on Stockpiling ventilators
Date:	4/4/2020 1:01:31 PM

And the question of availability of ventilators in general.  A friend who participated in a study of medical equipment tells me that the normal lead time from order to delivery of ventilators is 30-60 days, depending on the time of year and how they run their production. A normal year would see an order for 5-10 a year from a hospital.  So we know that the national stockpile of ventilators was created for one major incident.  Manufacturers are having to ramp up their production to surge capacilities.  You do not do this over night.  And right now the virus is moving faster than the production line.  Hence, the near term shortage.  I have no idea what their surge capacity looks like, but by all accounts, it is not easy to manufacture these and you have to keep your quality assurance up in the high 90s.  During a war time scenerio, you would have months to ramp up to surge capacity, but not in this case.  

So everyone seems to think that the answer to the longer term issue is to stockpile more ventilators.  But there is a problem associated with that - they likely need detailed maintenance to keep them in optimal condition.  Maintenance costs money.  A possible solution would be to rotate ventilators in and out of storage, to make sure you have useable material in times of the crisis.  But the stick is that hospitals buy ventilators and own and maintain them.  And I'm thinking that they probably buy from the same company to ensure that the users don't have to relearn how to use each one.  So hospitals that were willing to send their ventilators to the stock pile on a rotational basis would probably want the same ones back.  We know the the government no longer maintains anything itself but relies on companies to maintain it's equipment.  I have a feeling that ventilators are pretty sensitive pieces of equipment.  

I think back to the stockpiles of military equipment we had in Europe and drew down in the 90s.  This was pretty hardy equipment, but it had not been maintained and most of it was in too bad shape to repair it and ship it back, and the best of it was sold off to foreign countries, on an as is/where is basis.  

What we are witnessing and governors are crying about is that companies are in the ramp up to surge capacity and there is a lag time in what they can produce at this point, while still maintaining that quality assurance.  No one is going to be happy to get a bad ventilator.  So governors and the Democrats need to stop blaming the President for having no strategy and for failing them on the ventilator front.  I don't know what the President knew or when he knew it.  It's likely he didn't expect it to go as it has.  If these governors were as brilliant as they claim (and we know hindsight is 20/20) they could have taken actions to start ordering ventilators before the feds got involved.  But then it was a question of money and whose money will be spent to replenish their stocks.  And what will they do with all those ventilators, once the crisis is over?  How will they maintain them for the next crisis.

Name:	Carlson -	Reply
Subject:	Thoughts on Stockpiling ventilators
Date:	4/4/2020 1:48:55 PM

They should have you on the news!  Great explanation.  One though has to wonder what New York might look like if the Governor had embraced the use of the malaria drug at the time of a positive result?  

thanks again.  Not everything can be Trumps fault!

Name:	wix -	Reply
Subject:	CRD’s input could help.....
Date:	4/4/2020 4:04:10 PM

Perhaps, CRD could help explain the complexity of putting a patient on a ventilator and, more important, getting the patient off the ventilator successfully.  It ain’t always easy....

Name:	Talullahhound -	Reply
Subject:	CRD’s input could help.....
Date:	4/4/2020 6:34:54 PM

As i understand it, the longer you are on the ventilator, the harder it is to get you off.  

Name:	Carlson -	Reply
Subject:	advanced directives now!
Date:	4/4/2020 7:53:20 PM

if You have one update it.  If what Cuomo says is true that only 20% get off alive, count me out.  Everyone needs to update will and advanced directives (me included).  

Name:	PTClakefan -	Reply
Subject:	CRD’s input could help.....
Date:	4/4/2020 7:54:38 PM

That's my understanding as well.  If left on the ventalator too long, the patient's lungs start to slowly shut-down letting the device do the breathing for them.  If left too long, the damage can become almost irreversible.  As a former OR nurse explained to me on a boatride this afternoon, these patients need constant monitoring to keep them from getting to that state.  That is why you could have a gazillion respirators, but if you didn't have the people trained to use them, they are just another piece of equipment, that can do as much harm as good.  

Name:	Talullahhound -	Reply
Subject:	CRD’s input could help.....
Date:	4/4/2020 9:54:42 PM

My mother had emphysema, and she went into respiratory failure and they had to put her on a ventilator.  The Dr. told us that that the longer you are on it, the harder it was to get the patient off, and that could result in death, because they can no longer breathe on their own.  

Name:	CRD -	Reply
Subject:	CRD’s input could help.....
Date:	4/5/2020 8:41:39 AM

COVID19 is essentially leading to in severe cases,  what is known as ARDS, Acute Respiratory Distress Syndrome.  This condition has always been one that is a challenge to manage because of the need for, in many cases, long term respiratory support.  In order to maintain proper pulmonary toilet, a standard initial oral intubation is often followed by a tracheostomy.  Today's ventilators are indeed an engineering marvel.  They can breath for you, they can assist you while you are attempting to breath, they can apply pressure at the end of the expiratory cycle to keep portions of your lung alveoli open for further oxygenation, they can design an inspiratory and expiratory ventilation wave pattern, they can provide short bursts of ventilation among many other modalities.  There is protocol for weaning from a ventilator as medications are decreased that allow for more spontaneous effort which the ventilator will support, all to maintain approtpirate and physicologic oxygen levels. 

The longer that an individual is on a ventilator, the more risk that individual has for development of lung injury, where the lungs become too stiff (loss of compliance) to expand and the work of breathing becomes too excessive.  Think of a balloon.  The larger the balloon, the more difficult it is to blow air into it.  Then there is the risk of an actual bacterial pneumonia the longer one is intubated, caused by resistant bacteria in the hospital flora.  Those repiratory therapists and Intensivists that manage these cases are to be admired for the challenge they face in the ICU's today.  

I hope this helps!

Name:	GoneFishin -	Reply
Subject:	CRD’s input could help.....
Date:	4/5/2020 10:55:22 AM

Thanks for the explanation. From your post, it appears there could be more ventilators  shipped to a location than experienced staff could manage.

Name:	Shortbus -	Reply
Subject:	Alex Jones's input could help.....
Date:	4/5/2020 9:07:49 PM (updated 4/5/2020 9:10:44 PM)

https://www.infowars.com/bombshell-plea-from-nyc-icu-doctor-covid-19-a-condition-of-oxygen-deprivation-not-pneumonia/

Also I saw a message crawl on the news that Alabama had received dry rotted masks from the national stockpile.

Name:	wix -	Reply
Subject:	CRD’s input could help.....
Date:	4/6/2020 6:55:41 PM (updated 4/6/2020 6:56:53 PM)

Thanks for posting.  After seeing a few people in ICU’s on ventilators, I have always had a respect and fear for the operator and the patient.  To watch an anesthetized patient’s body struggle to overcome the action of the ventilator brings a real respect for the procedure...