Here I explore the nuances around the use of mechanical ventilation in 2020. It is not a simple story, contrary to many like Elon Musk that believe "the ventilators killed patients."
"I would instead argue that intubating early was not from explicit policies recommending early intubation but more from a lack of explicit policies or teaching which warned away from early intubation (same thing perhaps?)"
Mass ventilation for respiratory distress is actually a key component in the US, and international, repertoire of what is known as Disaster Medicine, which covers pandemics as well as bioterrorism events.
There can be no doubt that the well-established US disaster medicine plans were implemented in the ‘pandemic’ despite the known very high risks presented by ventilation and the acknowledged profound legal and ethical issues in enforcing a ‘collectivist’ approach in the form of ‘population-focused’ care.
A number of hugely contentious legal & ethical red flags are being raised in disaster medicine, including the suspension of individual rights with priority being placed on collective protection via population-focused care.
You craft your sentences well, and the cadence is very nice. It takes more than a course to create superb writing skills. You may have developed that from past years of school, encouragement from a special person, or from having enjoyed a lot of books. Best wishes.
I am in absolute agreement with your assessment of ventilators and their alleged role in ICU deaths. The recent series of posts clarifying the inaccurate attribution of deaths to ventilators was informative and necessary. Unfortunately, it seems a significant number of ER physicians and respiratory technicians apparently lack the necessary expertise and experience to know when or when not to initiate mechanical ventilation particularly apparent during the early days of the Covid outbreak in critical care settings.
As you know, complications from the use of ventilators still occur one of which is Ventilator Assisted Pneumonia (VAP) that in part describes lung infections due to pathogens and debris presumably propelled from the upper respiratory tract into the lungs during the typical high flow rates of air/O2 during the course of treatment. Migration of oral bacteria along the surfaces of endotracheal breathing tubes has also been well described. Of course, this phenomenon is not unknown to pulmonologists and respiratory therapists but, owing to the typical urgencies in ICU settings, time devoted to oral triage is not generally considered and those qualified to assess oral status prior to intubation are simply not found in ER settings. Oral anti-microbial rinses prior to intubation and periodically throughout the treatment course may reduce this likelihood but infections in the mouth can render the success of treatment compromised.
I have included a few references describing the role of oral infections and VAP the potential effects of which are overlooked in sick patients prior to beginning high flow respiratory rescue. Patients who have periodontal infections are at higher risk of respiratory failure and death due to VAP. Moreover, patients whose lung function is already compromised as in Covid and other respiratory conditions are at even higher risk of treatment failure in the ICU in my view.
My thinking here is consistent with your understanding that the sheer lack of early interventions in Covid patients was largely responsible for treatment failures and not the appropriate use of ventilation per se in the vast majority of patients who died in these critical care settings. I mean to say that oral infections can also be controlled earlier in the treatment process in conjunction with appropriate medical therapies to minimize interventional failures.
My contention is that markedly fewer patients would have been placed on vents if they had been given effective medication (ivermectin or hydroxyghloroquine) in the first place. Shame on the CDC for their poor covid protocols.
Yea you are right on some points about mechanical ventilation, in fact I’ll give you most as well as respect for what you do. However, I do not think Elon spoke out of line… it is true that the quick irrational jump to ventilate Covid patients was a horrible mistake, coming down from our health care agencies that have failed us for over 3 years now. Patients were not recovering as expected, lungs were not healing and multiple alveoli were in-fact exploding from positive pressure applied to them. I agree on your point on corticosteroids, and those should have been administered prior to quickly sedating and ventilating these poor folks, and what about the fact that it was to isolate Covid from hospital crew/other patients out of fear of contamination? I believe you spoke of that before. No, I had an experienced well thought of physician telling me once “they are not getting better on vents”, and that was a mystery at the time. And now it’s understood why it was bad practice…
Well argued with very solid rationale based on your vast experience. I knew I bought the FLCCC beach towel of you as a super hero, cape and all, to show off at the club for a darn good reason! Thank you for being the professional you are. Thank you for taking the daggers you and Paul have for the sake of humanity and good medicine. I sometimes wonder if either of you really grasp the importance of your deeds and your place in history. You didn’t do it to be heroes but you really are. Thank you!
I really appreciate this expert post (in the old sense of the word expert, not the Faucian sense), and it does shift my view.
Speaking for myself, I developed the "they killed people using ventilators" belief based on a nurse whistleblower working at Elmhurst hospital in NYC, combined with the extraordinary and inexplicable spike in mortality in NYC in April 2020 (but only April, when vents were in heavy use). I did presume incentives played a role because the behavior being described (and video recorded, and audio recorded) by this nurse was otherwise without explanation, but perhaps it was fear of contagion. The interview is here, if interested:
--treating people as "presumed covid" despite no positive test result
--venting people on the basis of a brief decline in O2 sat
--inexpert use of ventilators with incorrect PIP and/or incorrect medication
--writing and enforcing DNRs against the wishes of family (and against the wishes of nursing staff)
--having no patients ever come off a ventilator alive except one, a fentanyl addict who extubated himself
I did not think every hospital behaved this way and in fact the nurse says that too, but for a long time that spike in daily hospital mortality in NYC was begging for an explanation. It now appears, if you follow Jessica Hockett, that those data are, thankfully, fraudulent.
You may think it absurd, but hospitals DID kill patients for money. Why did they continue to use protocols that killed people and ignore treatments that saved people?
Only an expert vent geek could explain such a complex process so well. I must admit, I did not read everything in this post, but after losing my Dad on a vent many years ago before Covid and a cousin on a vent during Covid, I’ve been wondering about the technology as treatment.
You wrote: “Prior to Covid ever happening, most if not all patients who died in the hospital did so on a ventilator …”
I have NO medical expertise, but I’m wondering whether using ventilators as treatment before Covid (when most patients died on them) and during / after Covid should be replaced by something else. Of course, early treatment is the BEST treatment. But maybe we need a better tool for LATE treatment.
Not being a geek of any kind, I cannot suggest something better, I can only ask.
FLCCC’s team has done amazing out-of-the-box work with Covid and Covid Vax, Diabetes, Cancer, Sepsis, and more. Perhaps the same thought processes also could apply to ventilators. Could ventilators be a tool that belongs in an older toolbox?
For another take on hospital treatments, including ventilators, see Sasha Latypova’s posts here:
My understanding is that a patient is near death when the vent decision is made Their breathing requires more work than they are capable of and heart failure from lack of oxygen will occur. The premise is that with the vent they have a chance to recover from whatever else is failing. After watching the procedure, I know it was a difficult choice. While my wife recovered from that, it did contribute to her ultimate death months later (IMHO).
You say:
"I would instead argue that intubating early was not from explicit policies recommending early intubation but more from a lack of explicit policies or teaching which warned away from early intubation (same thing perhaps?)"
Mass ventilation for respiratory distress is actually a key component in the US, and international, repertoire of what is known as Disaster Medicine, which covers pandemics as well as bioterrorism events.
There can be no doubt that the well-established US disaster medicine plans were implemented in the ‘pandemic’ despite the known very high risks presented by ventilation and the acknowledged profound legal and ethical issues in enforcing a ‘collectivist’ approach in the form of ‘population-focused’ care.
A number of hugely contentious legal & ethical red flags are being raised in disaster medicine, including the suspension of individual rights with priority being placed on collective protection via population-focused care.
https://wherearethenumbers.substack.com/p/us-covid-19-ventilation-policy-made
VSRF Live Comedy Fundraiser will feature The War On Ivermectin book!
11/28/2023 Tuesday from 7:00 PM - 10:00 PM EST
https://givebutter.com/c/VSRF
You craft your sentences well, and the cadence is very nice. It takes more than a course to create superb writing skills. You may have developed that from past years of school, encouragement from a special person, or from having enjoyed a lot of books. Best wishes.
I am in absolute agreement with your assessment of ventilators and their alleged role in ICU deaths. The recent series of posts clarifying the inaccurate attribution of deaths to ventilators was informative and necessary. Unfortunately, it seems a significant number of ER physicians and respiratory technicians apparently lack the necessary expertise and experience to know when or when not to initiate mechanical ventilation particularly apparent during the early days of the Covid outbreak in critical care settings.
As you know, complications from the use of ventilators still occur one of which is Ventilator Assisted Pneumonia (VAP) that in part describes lung infections due to pathogens and debris presumably propelled from the upper respiratory tract into the lungs during the typical high flow rates of air/O2 during the course of treatment. Migration of oral bacteria along the surfaces of endotracheal breathing tubes has also been well described. Of course, this phenomenon is not unknown to pulmonologists and respiratory therapists but, owing to the typical urgencies in ICU settings, time devoted to oral triage is not generally considered and those qualified to assess oral status prior to intubation are simply not found in ER settings. Oral anti-microbial rinses prior to intubation and periodically throughout the treatment course may reduce this likelihood but infections in the mouth can render the success of treatment compromised.
I have included a few references describing the role of oral infections and VAP the potential effects of which are overlooked in sick patients prior to beginning high flow respiratory rescue. Patients who have periodontal infections are at higher risk of respiratory failure and death due to VAP. Moreover, patients whose lung function is already compromised as in Covid and other respiratory conditions are at even higher risk of treatment failure in the ICU in my view.
My thinking here is consistent with your understanding that the sheer lack of early interventions in Covid patients was largely responsible for treatment failures and not the appropriate use of ventilation per se in the vast majority of patients who died in these critical care settings. I mean to say that oral infections can also be controlled earlier in the treatment process in conjunction with appropriate medical therapies to minimize interventional failures.
REVISTA DE ODONTOLOGIA DA UNESPRev Odontol UNESP. 2013 May-June; 42(3): 182-187 © 2013 - ISSN 1807-2577ARTIGO ORIGINAL
Oral condition of critical patients and its correlation with ventilator-associated pneumonia: a pilot study
Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia
Zongdao Shi 1 , Huixu Xie, Ping Wang, Qi Zhang, Yan Wu, E Chen, Linda Ng, Helen V Worthington, Ian Needleman, Susan Furness
Periodontitis leads to VAP in ICU patients: A dental note
Rajiv Saini, Santosh Saini,1 and Sugandha Sharma
https://health.mo.gov/living/families/oralhealth/pdf/link-ventilator-pneumonia-mouth.pdf
My contention is that markedly fewer patients would have been placed on vents if they had been given effective medication (ivermectin or hydroxyghloroquine) in the first place. Shame on the CDC for their poor covid protocols.
I can see why you are such a great teacher; you're a phenomenal communicator!
Please tell us, if you already haven't (maybe in a future 'Stack) exactly when Remdesivir became widely used and why.
please listen to
https://takecontrol.substack.com/p/carbon-dioxide-biology
in particular at ~39:00...
Excellent thank you!
I hope you turn your head to deaths in doing people in the second half of 2021 next.
It is crystal clear that first-dose-mediated COVID exacerbation killed them.
https://vigilance.pervaers.com/p/us-summer-deaths-of-2021?utm_medium=reader2
was the hypothetical patient at 10,000 feet elevation or minus 200 feet below sea level?
why not increase the atmospheric pressure?
it would be relatively easy to pressurize an entire room.... Elon Musk must know how to do that if no one else does.
there are more questions that need investigation... https://brownstone.org/articles/does-new-york-city-2020-make-any-sense/
Yea you are right on some points about mechanical ventilation, in fact I’ll give you most as well as respect for what you do. However, I do not think Elon spoke out of line… it is true that the quick irrational jump to ventilate Covid patients was a horrible mistake, coming down from our health care agencies that have failed us for over 3 years now. Patients were not recovering as expected, lungs were not healing and multiple alveoli were in-fact exploding from positive pressure applied to them. I agree on your point on corticosteroids, and those should have been administered prior to quickly sedating and ventilating these poor folks, and what about the fact that it was to isolate Covid from hospital crew/other patients out of fear of contamination? I believe you spoke of that before. No, I had an experienced well thought of physician telling me once “they are not getting better on vents”, and that was a mystery at the time. And now it’s understood why it was bad practice…
Your experience and sharing it is priceless.
You are clearly in no “camp” which makes you irresistibly compelling to me.
Many thanks for taking the lumps and not giving up.
Well argued with very solid rationale based on your vast experience. I knew I bought the FLCCC beach towel of you as a super hero, cape and all, to show off at the club for a darn good reason! Thank you for being the professional you are. Thank you for taking the daggers you and Paul have for the sake of humanity and good medicine. I sometimes wonder if either of you really grasp the importance of your deeds and your place in history. You didn’t do it to be heroes but you really are. Thank you!
I really appreciate this expert post (in the old sense of the word expert, not the Faucian sense), and it does shift my view.
Speaking for myself, I developed the "they killed people using ventilators" belief based on a nurse whistleblower working at Elmhurst hospital in NYC, combined with the extraordinary and inexplicable spike in mortality in NYC in April 2020 (but only April, when vents were in heavy use). I did presume incentives played a role because the behavior being described (and video recorded, and audio recorded) by this nurse was otherwise without explanation, but perhaps it was fear of contagion. The interview is here, if interested:
https://off-guardian.org/2020/06/11/watch-perspectives-on-the-pandemic-9/
What the nurse describes is:
--putting covid + and - patients in the same room
--treating people as "presumed covid" despite no positive test result
--venting people on the basis of a brief decline in O2 sat
--inexpert use of ventilators with incorrect PIP and/or incorrect medication
--writing and enforcing DNRs against the wishes of family (and against the wishes of nursing staff)
--having no patients ever come off a ventilator alive except one, a fentanyl addict who extubated himself
I did not think every hospital behaved this way and in fact the nurse says that too, but for a long time that spike in daily hospital mortality in NYC was begging for an explanation. It now appears, if you follow Jessica Hockett, that those data are, thankfully, fraudulent.
You may think it absurd, but hospitals DID kill patients for money. Why did they continue to use protocols that killed people and ignore treatments that saved people?
Dear Dr. Kory,
Only an expert vent geek could explain such a complex process so well. I must admit, I did not read everything in this post, but after losing my Dad on a vent many years ago before Covid and a cousin on a vent during Covid, I’ve been wondering about the technology as treatment.
You wrote: “Prior to Covid ever happening, most if not all patients who died in the hospital did so on a ventilator …”
I have NO medical expertise, but I’m wondering whether using ventilators as treatment before Covid (when most patients died on them) and during / after Covid should be replaced by something else. Of course, early treatment is the BEST treatment. But maybe we need a better tool for LATE treatment.
Not being a geek of any kind, I cannot suggest something better, I can only ask.
FLCCC’s team has done amazing out-of-the-box work with Covid and Covid Vax, Diabetes, Cancer, Sepsis, and more. Perhaps the same thought processes also could apply to ventilators. Could ventilators be a tool that belongs in an older toolbox?
For another take on hospital treatments, including ventilators, see Sasha Latypova’s posts here:
* https://sashalatypova.substack.com/p/intent-to-harm
* https://sashalatypova.substack.com/p/chief-of-nuclear-chemical-and-biological
* https://sashalatypova.substack.com/p/pandemic-preparedness-a-government
* https://sashalatypova.substack.com/p/pandemic-preparedness-a-government
Again, I’m not judging, just asking questions.
My understanding is that a patient is near death when the vent decision is made Their breathing requires more work than they are capable of and heart failure from lack of oxygen will occur. The premise is that with the vent they have a chance to recover from whatever else is failing. After watching the procedure, I know it was a difficult choice. While my wife recovered from that, it did contribute to her ultimate death months later (IMHO).