Using ventilators may make sense from the perspective of medical science. Does it make sense from the financial and economic perspectives?

Ventilators are very expensive and in short supply.

I believe ventilators are saving lives, but could be used more effectively.

My profession is engineering (retired) and my sport is swimming in which life saving has been an essential part of training. Also in professional life in factories and laboratories, certifications in CPR of several types were required at different times.

Mouth to mouth CPR and Heart Lung methods proved effective and in 1958 replaced Holgar Nielsen push pull that had been used for decades and widely taught. Ventilators are a replacement for mouth to mouth when diseases are of concern.

I cover the older method in a thread.

https://www.researchgate.net/post/Why_Are_Victims_Of_Covid-19_Drowning_Without_Receiving_HN_Life_Saving_Treatments_That_Were_Taught_To_Swimmers

In this thread I mention that lying chest down helps drain fluid from lungs, as ventilation assistance and heart circulation assistance are provided.

The answer is that victims of disease must help in the decision making and management of treatment. Also simplified equipment and economical methods may help much of the world where ventilators at $50,000 each are not available.

Covid-19 also has danger of internal bleeding and blood clots which can be fatal in a percentage of patients, that must be managed separately from breathing.

Ventilators can fail when there are blood clots or lungs filled with fluid. There is room for efficiencies and economies in treatment that medical profession cannot fill completely.

It comes in election year and people who might help are old and at risk.

Jerry Decker I am not a medical professional. let's wait for opinions from the medical experts. The news reports that i have read says that the ventilators have not saved lives. i do not know how to assess these reports.

Ventilators help many patients; however, ventilators have not helped some patients who have rapidly worsened and died. An alternate method of helping COVID-19 patients to have less difficulty breathing is to help the bedridden patient to turn over periodically from the back position to the stomach position. The face-down stomach position may help some patients to breathe more easily. For some patients, turning over like this may enhance the air flow while they are inhaling and exhaling. In my opinion, the reason for this is that the natural force of gravity, however slight, makes breathing easier when the nose and mouth are closer to the ground.

What is the cost of human life?

The medical profession has been struggling to manage deteriorating patients with Covid-19. There are certainly some patients who would die without immediately being put onto a ventilator. The majority of these will die regardless but some will survive. Critical care is extremely expensive and benefits relatively few patients. Financially it would make more sense to improve primary health care for diseases such as hypertension and diabetes for the majority than provide critical care for the few. However healthcare is more often driven by emotion than economics.

Rajkumar Rajendram From a conceptual point of view, is it better to spend the money on other options for treatment rather than ventilators? Doctors are rational people and they are trained to decide in a rational manner. Doctors should not decide based on emotions. Agree?

Jes Jose

Jes Jose

Dr. Joseph Tham … thanks for this important question.

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I agree with Dr. Jes Jose comments.

Currently it is the only solution

Thaer Dawood Salman In some resource-poor settings, there is a shortage of ventilators. What do doctors do in such situations?

For COVID-19 just like any other disease: "A pound of prevention is better than tons of treatment."

Health care industry is influencing the Health care workers by introducing expensive new gadgets and treatments. Ventilators are such an example. Except for few young patients needing ventilators, most of the critically ill patients are having poor prognosis regarding return to normal life even when they survive. This is also the case for the management of ongoing COVID-19 pandemic.

More money is spent on research leading to discovery of novel, expensive treatments than prevention of diseases. Pharma industry will hardly ever sponsor any preventive research.

Only measure that has shown success till now with COVID-19 is by prevention i.e. compulsory social distancing, use of masks, hand hygiene, and self quarantine or isolation, and looking after the vulnerable in the society.

Dear Mr Joseph,

You have put forward interesting question. I think not only from financial point of view, but even from medical point of view we need to think about how much to stress on availability of ventilators.

The use of ventilators is not for cure, but mainly for support to patients who are critically ill and needs time to help treatment modalities to make them better. But to use a ventilator, you need skilled professionals which includes intensivists, critical care nurses, respiratory therapists, biomed technicians, etc. Intensivists are doctors who are specialized in critical care management. The proportion of these skilled professionals in the medical fraternity is quite low. One team of ICU care givers can to the most take care about a dozen or few more patients at a time effectively.

Hence in the scenario where patients are flowing into the intensive care for ventilatory support, in numbers that are humanly unimaginable, such as in Italy, Spain, USA and other countries, it becomes an impossible task for the experts in this field to keep everyone alive , even if hypothetically there was a ventilator and bed for each and every patient. Also the fact that in covid case management, due to infectivity and shortage of personal protective equipment (PPE), once a team uses PPE, they have to continue the long shift without being relieved in between, exhausting them. It is seen that in places where the patient load and the conversion rate of the infection was low, even the very elderly and patients with pre-existing diseases have been well managed on the ventilator and discharged home safely.

So more than machine power, its the availability of manpower who know how to use these machines correctly that matter, which takes years of training to procure.

But yes, in places where the ventilators are below the minimum required, it makes sense financially as well to procure ventilators.

Regards

Dr Joe Joseph

Human safety is presently the most significant relative to ventilator expenses.

Even though it seems like ventilators are about the only potent remedy, much financial energy should be channeled into meaningful research to find a cure. It's not impossible.

I think ventilators are not used to cure no to prevent the desease. They are used by critical patients who need support base, not just all patients, but those who can afford it. Let us play it safe and keep the safe and cheap way of preventing the covid 19. Stay home.

Ventilators are helpful in palliative medical care for some COVID-19 patients, but not all; therefore, ventilators should be made readily available even though only a fraction of patients will need them.

to use ventilators is essential, ofcourse it puts a lot of pressure to work with staff shortage, at least the availability of this resource would but an ease to the health care team in the long run, buy more time to save patients who go into critical phases. it is therefore essential to use this. If this resource is not available then also the health team would treat, somehow if a country is not having enough it is highly recommended to help them.

Nice Contribution Nthatheni Ramabulana

I think we can agree that virtually the only treatment for those in ICU has been to pump oxygen into them when their blood oxygen gets too low. Someone can sit there and do it, as happened with Boris Johnson - but then the sitters are getting a heavy viral load too. Ventilators do it automatically and are safer for medical staff - but they can result in long-term lung damage even if the patient does survive..

I have yet to see any evaluation that using ventilators saves lives. It probably does - the death rate seems to have gone up in Italy and New York when the system got overwhelmed. Even if half the people on ventilators die, that's better than 3/4 without them.

The cost of a ventilator is pretty steep and there is a worldwide shortage, but ingenious people in Africa and elsewhere have been coming up with lower-cost solutions that may work out. pandemicia.blogspot.com

I wonder if those asking for evidence that using ventilators saves lives would also want evidence that parachutes save lives when jumping out of an aeroplane.

There is a randomized trial of parachute use when jumping from aeroplanes that demonstrated that there was no significant difference in outcomes between those who used a parachute and those who did not.

Based on this arguement one should conclude that parachutes are not necessary when jumping out of aeroplanes...

However the devil is in the detail. The aeroplanes were stationary and on the ground.

As a consultant in intensive care medicine I have seen many patients who would have died without ventilatory support leave hospital after prolonged treatment with ventilation.

The first evidence that ventilators save lives was provided during the polio epidemic in Copenhagen in 1952 which resulted in the birth of the concept of intensive care.

Prior to Bjorn Ibsen's revolutionary use of manual positive pressure ventilation patients died of respiratory failure due to polio. Manual ventilation is uncontrolled and therefore more likely to cause complication than machine regulated mechanical ventilation.

Article The Physiological Challenges of the 1952 Copenhagen Poliomye...

It is unfortunate that the death rate is so high for those on ventilators (it is 25% for older people, with or without COVID, and 70% never return home).so it is surprising this question has not been asked before. The problem with severe COVID19 is that the oxygen level suddenly dives - so someone can sit there and feed oxygen, as with Boris Johnson) or one can use a ventilator, which is much safer for staff. I have not seen a proper evaluation of the CPAP alternative.

I did however see one figure that claimed with a ventilator the death rate fell from 75% to 25% in severe cases, which is more than enough to justify their use.The apparently much higher case mortality rates in Italy and New York, when they ran out of equipment and had to "choose who to save", might bear this out.