Rhonchi

Here is another piece I wrote dealing with the ventilator shortage problem.

In 1984 the Canadian Red Cross publicly informed hemophiliacs that the blood products it distributed were safe, even though not all sources of blood were tested. Spokesmen for the Red Cross also referred to the need to look at the cost benefit ratio in treating hemophiliacs. It was later found that more than 800 of Canada’s 2500 hemophiliacs had contracted AIDS from using the untested blood. About 95% of them contracted Hepatitis C. Even two years after it was known that untested and untreated blood was dangerous to use, the Canadian Red Cross was still distributing its older untested stocks.

This incident was a blot on the integrity of public health care organizations in Canada. Many people asked afterwards, “How could this happen?”, “They knew the dangers”. The answer of course was that they placed fiscal accountability and efficiency above the needs of the people that placed their trust in them. The Canadian Red Cross was not the only group that fell short of their responsibility. This same pattern was repeated by other organizations in other countries of the world as well.

We all tend to place a great deal of trust in organizations such as the Red Cross. Such groups we trust are the FDA, the CDC, HHS. In Canada we have The Ontario ministry of Health and Long Term Care, Health Canada and The Public Health Agency of Canada. These groups have developed plans to deal with a pandemic. They all acknowledge that there will be a severe shortage of ventilators. The plans they have to increase the availability of ventilators fall far short of even their own predictions. Again they know the dangers, but are not doing enough to solve the problem. They have to be fiscally accountable and efficient you know. That old cost benefit ratio.

They have a plan to deal with it though; it involves rationing. They will pick who lives and dies. You can find lots of these plans on the web. Just Google Pandemic Ventilator Plan Ration. Now Ontario, Canada where I live, has 1,096 ventilator support beds in ICUs in the province. The total demand for ventilators in a pandemic could easily be twice this amount. There are also 1,400 chronic ventilator patients on other ventilators. The published triage plans are not very specific on whether it will involve taking ventilators away from sicker chronic patients to give to the pandemic patients. I hope we can trust them.

for more information you can see my blog at
http://panvent.blogspot.com/

Some of the current plans for dealing with the expected shortage of available ventilators in a pandemic crisis depend on stockpiling manual ventilators (ambu-bags). They would arrange for teams of friends and family members operate the ambu-bags during the crisis. There is some disagreement as to whether this is a viable option. Some experts dismiss this as being totally unworkable in a mass casualty situation as there are three basic problems with this plan:

1. The physical effort of squeezing a bag continuously is too exhausting for a person to manage very long.
2. Infection control issues related to having many volunteers man the bags in an ICU full of contagious flu victims. The number of deaths due to additional infections generated by such a plan could actually be greater than the number of people saved with the manual ventilators.
3. Lack of monitoring combined with minimally trained volunteers will probably result in a very high morbidity and mortality for the patients.

Now of course it is possible for a team of trained experts to keep someone alive on a manual ventilator for an extended time. In 1955, as a result of a polio epidemic, the demand for negative pressure ventilators exceeded the availability of negative pressure ventilators. There was such a shortage in Sweden that medical students, working in shifts, manually ventilated patients to keep them alive. Now a polio epidemic may sound bad, but the number of patients requiring mechanical ventilation in a flu pandemic will probably be many times higher.

Now instead of throwing our hands in the air in a panic and crying doom, suppose we looked for a way to solve these three problems. Number 1 is easy to solve. Just take an electric motor with some gear reduction and a cam arrangement, to make a pair of mechanical hands to squeeze the bag. The operator can now just turn a control knob to speed up or slow down the rate, or press a button for each cycle if you wanted to have some sort of assist mode going. If you solve problem #1, you also solve problem #2 because you do not need that large group of volunteers.

Solving problem #3 is a little harder. You would need a pressure sensor and an electronic controller to analyze the pressure conditions in the ventilator circuit to determine when alarms such a low rate, high pressure and disconnection occur and sound an alarm. A rudimentary but functional device could be constructed from any standard instrumentation pressure sensor and basic industrial programmable logic controller. If someone worked out a good program ahead of time that was well tested, this could be freely shared to run thousands of devices across the country.

Incidentally, if you were fortunate enough to have stockpiled a quantity of pressure driven transport ventilators ahead of time, you do not get problems #1 and #2. The same monitoring system could be used to enhance safety of these devices for unattended operation.

Clarence Graansma
For more information you can visit my Pandemic ventilator Project blog at http://www.panvent.blogspot.com/

I like that ALA:

FFS – Handout 45: 52 Proven Stress Reducers – American Lung Association site : Procrastination is stressful. Whatever you want to do tomorrow, do today; whatever you want to do today, do it now.

The Observer | UK News | Lung patients ‘getting poor treatment’

Thousands of patients with chronic lung disease are being misdiagnosed and receive poor hospital care, according to the Healthcare Commission.

A national study of chronic obstructive pulmonary disease (COPD), which affects up to one in 20 Britons, has revealed that many patients are receiving very sub-standard treatment. The report, to be published on Wednesday, is expected to say that this may be because of a stigma that it is a ‘smoker’s disease’ and because some people feel that little can be done for patients.

I don’t see the report on the UK Healthcare Commissions site: http://www.healthcarecommission.org.uk/ 

deseretnews.com | Variety of things can trigger asthma
The triggers for asthma run the gamut from the obvious to the odd — not just secondhand smoke and cat fur and perfumes and pollen but vigorous laughing or a good cry. Anything that irritates the lungs can make a susceptible person wheeze or worse, explains respiratory therapist Valerie Morgan-Wallace.

winnipegsun.com – Tom Brodbeck – Crisis at Seven Oaks
But the hospital couldn’t find a qualified ER doctor to fill the shift and had to make do with a family physician instead. Because family physicians are usually unable to handle more serious ER cases, the hospital also planned last night to divert all red and amber ambulance cases to other hospitals, Winnipeg Regional Health Authority spokeswoman Heidi Graham said.

An extra ambulance was added to last night’s shift to help handle the load, said Graham.

Meanwhile, the hospital had to staff the ER with a respiratory therapist to handle resuscitation cases because family doctors don’t do resuscitation, according to the WRHA.

Score one for the RTs!

TheDenverChannel.com – Health – Showers May Be Giving Some Women Lung Infection
Doctors across the country are seeing an increase in a bacterial lung infection called non-tuberculous mycobacteria or NTM.

There are not enough studies out right now to show exactly how a person gets the infection but some doctors believe it is possible to get it from hot tubs or even by taking a shower.

It is a lung disease that doctors say starts from germs that reside in the water and soil. It is even possible to get it from hot, steamy showers.

One of the theories of NTM is that germs become air-born because of the mist from the hot water.

More about Nontuberculous Mycobacteria

Viet Nam News
The German Messer Industrial Gases Group’s Dr Hans Messer Foundation donated medical equipment valued at US$20,000 to the National Hospital for Obstetrics and Gynaecology’s Neonatal Department in Ha Noi yesterday.

The batch of five respiratory therapy or continuous positive air pressure (CPAP) machines, six phototherapy machines, three pulse oximeter monitors, three infant warmers and three incubators was presented by the group’s CEO, Stefan Messer.

The donation forms part of the Breath of Life programme of the non-governmental East Meet West (EMW) Foundation. The programme aims at reducing mortality rates among premature babies in Viet Nam. It is estimated that over 128,000 babies are born prematurely in Viet Nam each year and of those, 10 per cent suffer respiratory distress. About 12,000 babies will die and many more suffer brain damage from oxygen deprivation unless equipment, especially CPAP machines — standard equipment in developed countries — is available for intervention.

I like to see this kind of humanitarian donation.

Lung Cancer May Differ by Gender – Forbes.com
Women may experience lung cancer in ways that differ from men, a new study finds.

Many women recently diagnosed with lung cancer have normal lung function and better results on lung function tests than newly diagnosed male lung cancer patients, say researchers reporting in the May issue of the journal Chest.

Position: Respiratory
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