Innovative new techniques....

[kadee79]

What say you PMD?....sounds like good works happening to me.

Dr. Robert Cerfolio says his "aha" moment came at the bedside of a COVID-19 patient, who seemed literally to be suffocating to death on his own mucus. After hearing the code for a cardiopulmonary arrest, Cerfolio had rushed into the unconscious patient's room and pulled out the thin ventilator tube delivering air into his lungs, to find it stopped up with discharge that had hardened to the consistency of concrete. 
"Why aren't we doing a bronchoscopy?" Cerfolio called out, referring to a procedure where physicians snake a thin scope through the tube in a patient's airwaves and suck out obstructions. "This guy's not dying of COVID. He's dying of an obstructed tube!" It was the early days of the crisis in New York City back when NYU Langone Medical Center still had only a handful of COVID-19 patients. (The hospital declined Friday to give a precise current number, only saying "hundreds and hundreds.") The answer that came back from the doctors in attendance was not what Cerfolio expected to hear. We aren't allowed to, they told him. The procedure, which involved threading a smaller tube into the respirator conduit and down into the airways—and then pulling it out—could "aerosolize" the virus, dispersing it through the room and possibly infecting all the front-line health care workers around it. Which is why statements instructing against the procedure had been issued by a wide range of surgical and medical professional organizations.

www.msn.com/en-us/health/medical/how-doctors-are-saving-coronavirus-patients-with-innovative-new-techniques/ar-BB12rQp6?li=BBnb7Kz

[pulmonarymd]

Yeah, again a simple idea for a complicated problem. This is nothing new, problem can happen in multiple diseases. Infection risk is a major issue, as is the risk of making someone worse. A bronchoscopy will cause a patients oxygen level drop significantly, so you need room to increase it to compensate. If you don't have that luxury, it is high risk. More importantly, it would be one thing to do it once. There is no reason to believe that the obstruction will not occur again, as there is no treatment to prevent it from happening. Finally, there are a limited number of people capable of doing the procedure. In the situation in NYC, there is not enough time, and the people doing t have a high risk of getting sick. Then they are not available for the other patient's care. Unless you want an Orthopedic Surgeon managing your ventilator.

[kadee79]

More from the article....

Cerfolio overrode the guidance. The patient lived. And Cerfolio and his colleagues at NYU Langone developed a new protocol for protective equipment and other precautions for doctors willing to do the procedure. They have since performed bronchoscopies on hundreds of COVID-19 patients.

Luis Angel, one of Certfolio's colleagues, invented a new self-contained method for tracheostomies that can sometimes keep doctors from putting critically-ill patients on ventilators, which requires them to be put in a medically induced coma. The procedure, which requires incisions into the lower neck, is known to place health care providers at risk, but if safely performed allows doctors to use a bigger tube than is used for ventilation, one that is easier to clean. 
NYU posted a video demonstrating the procedure, and Cerfolio's phone lines lit up.

"I've been called by the head of thoracic surgery at the main academic institution in Spain, I've talked to a guy in Italy and we're doing the exact opposite of what they have done there—even at Columbia the head of thoracic surgery over there called me and said, 'I heard you guys are doing traches, what the hell you doing?'" Certfolio says. "We've done 63 of these and not a single doctor or nurse has gotten sick—not one. Sixty-two of the patients are still alive. We know we can do it safely and we know we are helping patents."

As COVID-19 washes over the United States, doctors in hotspots across the nation are still deciding how best to battle a mysterious and deadly disease scientists don't yet fully understand. And while many are looking to the experience of health care providers in China and Europe, they are also racing to develop new procedures of their own and debating best approaches—often on the fly. In the fast-moving environment of a novel worldwide pandemic, there's not always time to wait for medical journals to publish. And the flood of reading material is growing so vast it's hard for many to track. So every day, clinicians around the world are helping each other as they find their way, trading and debating tips through social media, over conference calls and even over old medical school email chains.

[kadee79]

And another procedure/protocol

On the other side of the nation, Dr. Tom Yadegar, a pulmonologist and medical director of the intensive care unit at Providence Cedars-Sinai Tarzana Medical Center in California, had his first "aha" moment when he got his first patients last month.

In those early days, he treated both a 60-year-old patient and an 80-something man, both of whom arrived stable, with good vitals, and normal X-rays, then spiraled into a rapid decline for seemingly no reason. Both ended up on ventilators, which drove Yadegar to the literature.

Through his research Yadegar realized that what he was seeing was a "cytokine storm," an overactive inflammatory reaction often seen in the sickest COVID-19 patients, a reaction so virulent it can kill. Soon he identified several blood markers, like the levels of ferritin, a protein that contains iron, that seemed to predict which patients were most likely to develop the overactive immune response. He wrote up protocols for his staff to follow that have them sometimes administering immunosuppressant drugs normally used to avoid organ rejection, to patients who seem likely to get in trouble.

"Up until a month ago, I didn't know about cytokine storms," he says. "I wasn't looking for it. It's not intuitive. And then to treat it, you're doing something that you probably have never done in your life, which is to give a patient in the ICU strong medications to suppress the immune system. It's totally counterintuitive."

Though similar protocols had previously been reported in China, Yadegar's experience was the first time many of his local peers had heard of the approach. He estimates he's kept three critically ill patients off of ventilators, and removed three more as a result of the protocol, and is now overseeing COVID-19 response in two affiliated area hospitals. Yadegar extended the impact of his finding by sharing his experiences with 50 or so fellow graduates of USC Medical School on a weekly call coordinated by his old program director. He then was interviewed about his approach on Fox and Friends, which prompted a floor of inquiries from other caregivers across the nation.

[kadee79]

Apr 10, 2020 14:52:44 GMT -5 pulmonarymd said:

Yeah, again a simple idea for a complicated problem. This is nothing new, problem can happen in multiple diseases. Infection risk is a major issue, as is the risk of making someone worse. A bronchoscopy will cause a patients oxygen level drop significantly, so you need room to increase it to compensate. If you don't have that luxury, it is high risk. More importantly, it would be one thing to do it once. There is no reason to believe that the obstruction will not occur again, as there is no treatment to prevent it from happening. Finally, there are a limited number of people capable of doing the procedure. In the situation in NYC, there is not enough time, and the people doing t have a high risk of getting sick. Then they are not available for the other patient's care. Unless you want an Orthopedic Surgeon managing your ventilator.

I think there is a lot more in the article other than just what you commented on...and possible new ways of doing things that are safer for all involved?

[pulmonarymd]

Apr 10, 2020 15:49:37 GMT -5 kadee79 said:

And another procedure/protocol

On the other side of the nation, Dr. Tom Yadegar, a pulmonologist and medical director of the intensive care unit at Providence Cedars-Sinai Tarzana Medical Center in California, had his first "aha" moment when he got his first patients last month.

In those early days, he treated both a 60-year-old patient and an 80-something man, both of whom arrived stable, with good vitals, and normal X-rays, then spiraled into a rapid decline for seemingly no reason. Both ended up on ventilators, which drove Yadegar to the literature.

Through his research Yadegar realized that what he was seeing was a "cytokine storm," an overactive inflammatory reaction often seen in the sickest COVID-19 patients, a reaction so virulent it can kill. Soon he identified several blood markers, like the levels of ferritin, a protein that contains iron, that seemed to predict which patients were most likely to develop the overactive immune response. He wrote up protocols for his staff to follow that have them sometimes administering immunosuppressant drugs normally used to avoid organ rejection, to patients who seem likely to get in trouble.

"Up until a month ago, I didn't know about cytokine storms," he says. "I wasn't looking for it. It's not intuitive. And then to treat it, you're doing something that you probably have never done in your life, which is to give a patient in the ICU strong medications to suppress the immune system. It's totally counterintuitive."

Though similar protocols had previously been reported in China, Yadegar's experience was the first time many of his local peers had heard of the approach. He estimates he's kept three critically ill patients off of ventilators, and removed three more as a result of the protocol, and is now overseeing COVID-19 response in two affiliated area hospitals. Yadegar extended the impact of his finding by sharing his experiences with 50 or so fellow graduates of USC Medical School on a weekly call coordinated by his old program director. He then was interviewed about his approach on Fox and Friends, which prompted a floor of inquiries from other caregivers across the nation.

You see all sorts of claims early on in any new disease, especially pandemics. Everything gets thrown against the wall to see if something sticks. This, for example, is based on observations from years ago, and we have attempted to manipulate the immune system in people who are acutely ill from infectious in many different ways. I am old and cranky at times, but newer physicians sometimes think they invented the wheel. I have seen us go in a circle with how we treat things at times. The bronchoscopies, they are doing it because they can. Some people believe in doing them alot, and apparently NYU, my alma mater believes in it. If it was truly effective, how many people die there, compared to places that aren't doing it.

I understand the need to find hope in anything that seems remotely promising, but the thing to remember is that most new treatments do not work. Eventually, something will be found to be effective, but all this is anecdotes. The gold standard for any treatment that we try on acutely ill people is mortality. Until we have data showing that a group who got the treatment survives more than one who didn't, I remain skeptical.

[happyhoix]

On the news tonight they were talking about a potential treatment using a drug originally planned to be used against Ebola. They’re doing a double blind study at Emory and a lot of people are recovering more quickly than expected- won’t know for several weeks yet if it’s the placebo group or drug group- fingers crossed.

[pulmonarymd]

Apr 13, 2020 19:16:27 GMT -5 happyhoix said:

On the news tonight they were talking about a potential treatment using a drug originally planned to be used against Ebola. They’re doing a double blind study at Emory and a lot of people are recovering more quickly than expected- won’t know for several weeks yet if it’s the placebo group or drug group- fingers crossed.

This is the most promising treatment in my opinion