Drudge Retort: The Other Side of the News
Wednesday, April 08, 2020

Josh Marshall: A New York City emergency and critical care physician Cameron Kyle-Sidell th(inks) the treatment protocol and basic understanding of acute COVID-19-induced respiratory distress (are) both wrong. He said that what he is seeing in his ICU does not look like pneumonia but rather oxygen deprivation (hypoxia) ... Critically, he argue(s) the high pressure ventilation might be damaging the lungs.



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He was saying that the disease model most doctors are working with " pneumonia/ARDS " is not what these patients are presenting with and the treatment protocol is incorrect. He was cautious and tentative in his conclusions, just what you'd expect from a serious clinician. His argument was that it is a different syndrome requiring different treatments. Ventilators are the best treatment we have now, he said, but they should be used differently (different use of pressure, well beyond my understanding). It seemed legit. But obviously I have zero understanding about anything to do with respiratory disease or its treatment.
That makes two of us, but I thought some of our resident posters who'd better understand this (calling JPW, Snoofy, etc.) will come along and help educate us.

This is the second story that I've found so far that speaks to different protocols of treatment for Covid. It's great to see independent minds trying to defeat this enemy and give its victims a hand up in surviving it.

#1 | Posted by tonyroma at 2020-04-07 07:06 PM | Reply

As I understand the escalation of treatment for COVID-19 disease, it's
Oxygen, then add,
Intubation, then go to,
Ventilator, then pray.

I don't know how last line of defense care is adapting to the unique challenges of a novel disease, but I know that how ventilators are used in general has changed over the years. I think maybe they generally try to breathe for you as little as is needed, rather than force their mechanical will on you? But I am not knowledgeable about this stuff.

#2 | Posted by snoofy at 2020-04-07 07:31 PM | Reply

My understanding is ventilators work by forcing the oxygen into your lungs. It has to expand your lungs to a volume equal to or slightly larger than max in order to compensate for lost O2 absorption and function due to tissue damage and edema.

People think the nightmare is over if you survive when actually severe COVID and ventilation will likely result in people permanently losing lung capacity and function.

#3 | Posted by jpw at 2020-04-07 08:07 PM | Reply | Newsworthy 1

In any case this doesn't make much sense to me as the danger with pneumonia IS hypoxia. He seems to be saying the same thing just slightly differently and I'm not sure what the ultimate point is.

#4 | Posted by jpw at 2020-04-07 08:10 PM | Reply | Newsworthy 1

He seems to be saying the same thing just slightly differently and I'm not sure what the ultimate point is.

Again, idiot about to speak, but here goes. I think what the doctors (the others around the world finding agreement) are saying is that the current protocols are based more on increasing the amount of air into the lungs by increasing the pressure of the air from the ventilator into the lungs - where they believe the emphasis should be on increasing the quality of O2 absorption through observing individual patient physiological and phenotype factors, which often results in lowering the ventilator pressures, not raising them. Here's what the doctor in Italy has anecdotally observed:

Dr. Gattinoni and his colleagues explained further that ventilator settings should be based on physiological findings " with different respiratory treatment based on disease phenotype rather than using standard protocols.

"This, of course, is a conceptual model, but based on the observations we have this far, I don't know of any model which is better," he said in an interview.

Anecdotal evidence is increasingly demonstrating that this proposed physiological approach is associated with much lower mortality rates among COVID-19 patients, he said.

While not willing to name the hospitals at this time, he said that one center in Europe has had a 0% mortality rate among COVID-19 patients in the intensive care unit when using this approach, compared with a 60% mortality rate at a nearby hospital using a protocol-driven approach.

Hope I re-explained that semi-accurately.

#5 | Posted by tonyroma at 2020-04-07 08:45 PM | Reply

Your comment didn't address mine.

Altitude sickness is caused by....edema!

Same thing as those with severe COVID.

So of course they're going to look similar-patients in both cases can't properly oxygenate because they're essentially drowning in their own serum and blood.

#8 | Posted by jpw at 2020-04-08 12:19 AM | Reply

Call me stupid but I think I'll listen to the actual doctors.

#9 | Posted by danni at 2020-04-08 11:00 AM | Reply

#9 Nah! Doctors are just deep state actors solely focused on preventing Donald Trump's re-election.

It's aquarium cleaner and only aquarium cleaner for derp derp!

#10 | Posted by bocaink at 2020-04-08 11:14 AM | Reply | Funny: 1 | Newsworthy 1

Danni, this thread is about the findings of actual doctors that are treating patients with Covid 19.

We're making comments about those findings. No one here is trying to play doctor.

#11 | Posted by tonyroma at 2020-04-08 11:16 AM | Reply

I recommend trying one bourbon, one scotch and one beer to fight coronavirus...
--John L. Hooker, well-known blues raconteur

#12 | Posted by catdog at 2020-04-08 01:10 PM | Reply

Call me stupid but I think I'll listen to the actual doctors.


Which ones?

#13 | Posted by jpw at 2020-04-08 04:53 PM | Reply

Another doctor's viewpoint:

Possible Developments in the Treatment of Critical COVID-19 #2

In most cases of respiratory failure (pneumonia, heart failure, ARDS) the small air cells, the alveoli, fill up with fluid or collapse. So we maintain a higher constant pressure (PEEP: Positive End Expiratory Pressure) in the airways to hold them open, and it works well. Um, usually. But COVID seems to be different. More oxygen (normal room air = 21% O2) by which I mean a higher fraction of oxygen delivery up to 100% definitely helps. But the positive pressure ladder which worked well in ARDS seems maybe not to work in covid, and maybe even harms the lungs. We've always known that a high level of positive pressure is a double edged sword, but in covid maybe the harms clearly exceed the benefits, which would be truly new.

This is not to say we should not ever intubate. But it does mean that a) we should avoid intubation as much as possible by increasing the inhaled oxygen and b) if we do have to intubate, then the high positive pressures we have traditionally used maybe are to be avoided, even if it means allowing the blood to have less oxygen in it that we would traditionally accept.

So why would we intubate if it's harmful? So traditionally we would intubate for "low oxygen level" - and this (maybe) is out the window. But if a patient is too exhausted to continue to draw air in, or too out of it to protect their airway, these are still obligatory reasons to intubate. We can't get around those. But it's seeming clear that anything we can do to increase the number of ventilator-free days is a good thing, and this is a new understanding.

And having seen the videos, I also have to say the "crazy" hypothesis remains valid. But Dr Kyle-Sidell may be crazy but I don't think he's wrong. To be clear, he is also not a "lone voice" in the wilderness. He's reflecting an evolving consensus among docs who have managed a lot of covid.

#14 | Posted by tonyroma at 2020-04-08 08:14 PM | Reply

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