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Comment by robbiep | Hacker News Reader

Prolonged ventilation is damaging to the lungs. But ventilation is not given lightly - usually it is for an acute deterioration and is life saving (ie without it, patient would have died in that instance).

Interestingly in COVID it appears that positioning and CPAP/BIPAP can be more effective that venting in edge cases. This is a very new phenomenon in medicine, and we probably over vented in the early course of the pandemic. We were acting in what we knew of other severe respiratory diseases, and the case data from COVID hadn’t had enough time to present best treatment modalities.

However, to suggest that the lungs are not being absolutely ravaged by the virus infecting, replicating and rupturing lung cells is ludicrous

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> However, to suggest that the lungs are not being absolutely ravaged by the virus infecting, replicating and rupturing lung cells is ludicrous

I was talking about permanent damage. I actually read my comment again, and that isn't really clear.

Doctors in Italy are saying that ventilators were thought to be useful because people complained that they couldn't breath, but now they're saying that it's not the lungs that aren't working, but it's oxygen that is not carried out in the blood, and that ventilators can actually cause permanent damage in many cases.

I'm not a doctor, so I just base everything on what the (supposed?) experts are saying. As far as I know they might very well say that on TV because there aren't enough ventilators, no idea.

One of the reasons we worked out we could get people through without ventilators was because we ran out of ventilators. And people with COVid are being vented for 2 weeks plus. A normal time (and a time that would minimise Kung damage from a vent) would be several days.

But if someone has saturation’s in the shithouse, they’re going to die. Lack of oxygen (Hypoxia) in the blood is many many fold more common than severe thrombosis or whatever else was suggested; and the answer is right there - if the oxygen isn’t getting to the blood it’s because the lungs are shot. If we have enough gear, we put someone in ECMO to solve the gas exchange problem.

Lung damage severe enough to do this is caused by the effects of the disease, not the ventilator

I see. I guess it was just one theory.

What you're saying makes sense, thanks for explaining.

When did we run out of ventilators?

As far as I know nowhere ever ran out of ventilators, not even in Lombardy. But I sure saw that claim made a lot of times back when people thought that would happen. Spent a lot of time pointing out the authorities were denying it'd happened too. I concluded it's very easy for people to mix up "we think this is about to happen" with "this has happened".

Lombardy was utilising operating theatres and had ICUs and trauma bays full (70-80% is full because you have lost lost of your surge capacity), using the vents in all these areas. There was a shift to NIV because once you have no vents you let people die

80% isn't full. 80% is 80% full and is about normal for an ICU. The whole point of having some headroom is you can lose it without being full!

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