I have not found any numbers. Ventilators help but are not a cure.

“Are they worth it?” – Like you I argue yes. Air may not cure you but no one wants their breathing cut off. We have one doctor who watched her daughter die of ARDS so I deffer to her very real description.

Can a state affored 35,000 vents that cost $10k each and total 350 million? They can affored 350 million dollar building or highway so why not something that will save lives. They may get a bulk discount.

As a nation will we pay for vents that will most likely only be used once? This is a deeper question that McCain and Obamma should answer as our next leader. So far both have dodged the requests.

Some do argue no as ventilators are not a cure and may only prolong suffering and false hope while expending large sums of scarece monies. Their argument is sound in some respects.

Yes – “an ounce of prevention is worth a pound of cure” and the N-95 masks are but one possible bit of prevention. Technicaly masks have not been proven to be effective.

Regards,
Kobie
“The only winning move is not to play” – The Whopper computer from the movie “War Games”

Thanks Goju and Kobie for the supplemental ventilator information. The survival rate in Indonesia gets me thinking along these lines…

1. Survival rate on a ventilator could be less than, say 5 percent. I’m assuming that you are on a ventilator because you have advanced (respiratory distress) symptoms.
2. Those who do survive have significant health issues (perhaps for the rest of their lives)
3. Properly using ventilators is a skilled task, and is manpower intensive

Are they worth it???

One analogy is the use of CERT teams in a large-scale disaster. We teach them to NOT initiate CPR during a mass casualty/injury event. Why? Once CPR is initiated, there is a legal and moral obligation to continue CPR until the responder(s) is either exhausted or relieved. The cost is other victims NOT being treated on the slight chance that someone whose heart has stopped will be saved, when they can finally be brought to definitive care. So, you do the most good for the most people.

Please don’t construe this as meaning we shouldn’t use ventilators for pandemic flu victims. Rather, two things for consideration:

1. If there is a shortage of healthcare professionals, there may be cases where the most good for the most people is realized, for example, by taking care of those showing early symptoms, and a good chance of recovery.

2. If the survival rate of ventilator patients holds true, the cost/benefit ratio can’t be very good…implying that we should have a very large (and adequate) supply of N95 masks BEFORE we spend scare dollars on ventilators.

Just thinking, and would appreciate thoughts from the healthcare perspective.

I you are interested in a discussion on ventilator Triage here is the N.Y. vent thread from April 2007

http://www.newfluwiki2.com/showDiary.do?diaryId=1081

Note, the comments may seem flippant at times for these folks get along and some levity keeps things from falling apart.

Side issues are often brought up because things do not happen in a vacume and so there are guidlines explaining what else need be done; what else need not be done.

Laqueta,

You are quite right about people possibly shedding virus before showing symptoms. In a hospital environment the patient is already sick so cross contamination is to other staff and visitors / family. This brings up issues.

In my *opinion* if people believe there is nothing they can do they will either fight to do something, leave adn run away or give up and “party like there is no tomorrow”
H5N1 is not the end of the world, not even close. So having the public see adn believe they can get through H5N1 even though help will not arrive (calvery is calling in sick with H5N1) is beneficial. Just my *opinion*

Regards,
Kobie
“If you think you can or you think you can not – you will be right” Henry Ford, US inventor

There are several types of vents. Making them is not as hard as having trained medical people. Here is a story from India about how they got Nebulisers and have not used them because of power and personnel.
Story is Cached from Google:
http://64.233.169.104/search?q=cache:OaKtWcYSMaQJ:www.thestatesman.org/page.news.php%3Fclid%3D23%26theme%3D%26usrsess%3D1%26id%3D215712+Nebulisers+kept+unused&hl=en&ct=clnk&cd=1&gl=us

Yes people are looking at building their own.

Like Goju and SDHDTraining I wish there was more on the role of ventilators. The article on cytokine storm Goju cited is good. Yes there are secondary complications from cytokine storm. Also the use of pure Ox is required. Because the avioli of the lungs are full they are less effective – like breathing on one lung or less.

Kathy,

You bring up a good point. So far the hardest thing was helping edit the N.Y. vent triage document. It is necessary to have guidelines and legal protection in place, reviewed and understood *before* they are needed.

I hope your hospital / care facility has one.

Some points are 1) those on ventilator or partial ventilator support will not have their ventilators removed to aid others. 2) Legal recourse for when the parents do not agree with treatment change. 3) Security 4) Counseling. 5) councilling for staff.

Kathy note: if under a 1.5% CFR a hospital with 5 free vents gets 50 patients, 45 will not get treatment but palliative care to make their last hours as comfortable as possible. Why? Recovery on a vent takes days. Time those waiting for a vent may not have.

Please correct me if I am wrong.

It does not have to be this way. In 1850 we did not have ventilators. In 1918 we did not have ventilators. This is the 21st century. Please look at this youtube high school project vent http://www.youtube.com/watch?v=liOQ9P2urOM

This high school ventilator is not a solution but shows what can be done.

Laqueta,

You bring up a lot of good points. I’m not sure in what percentage they will play out. In 1918 people sank back into their homes as kids watched the funeral carts pick up neighbors. School was a time to see who was left. In 1917 life expectancy was 48.4 for women, 54.0 for men. In 1918 this dropped to 36.6 for women and 42.2 for men.
Yes Influenza did more damage than the World War I on life expectancy.
Source: http://www.demog.berkeley.edu/~andrew/1918/figure2.html

Hence because we are used to a safe world where death is far less common and doctors cure people I’m not sure how your thoughts will play out but agree with you. Keep thinking.

I hope you all keep thinking and asking questions.

Please remember “The whole is greater than the sum of its parts” – Gestalt

Regards
Kobie
“United we stand – divided we fall”