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March 31, 2020

BehindTheMedspeak: Actually, there's no ventilator shortage — Part 2

Yesterday's Part 1 offered a simple low-tech solution to the acute shortage of mechanical ventilators for patients requiring controlled ventilation.

A reader demurred:


An Arab proverb applies:

The dogs bark, and the caravan moves on.

Last night reader Rocketboy_X commented thus:

Screen Shot 2020-03-31 at 6.11.53 AM

I had my Crack Research Team©® drill down and sure enough, they discovered that New York's Governor Cuomo is thinking along exactly the same lines as me.

From a March 28 CNBC story:






Note to Governor Cuomo: Perfect is the enemy of good (enough).

I would add that it doesn't require being in the National Guard to squeeze an breathing bag 10x/minute: as I noted yesterday, anyone who can make a fist can do it.

With an experienced nurse, respiratory therapist, or doctor directing, there's no reason why a bank of Ambu bags, protected and separated from intubated patients by plexiglass dividers, couldn't deliver artificial respiration 24/7 to multiple intubated Covid-19 patients in the event machines aren't available.

This just in two hours ago:

Screen Shot 2020-03-31 at 7.59.12 AM copy



March 31, 2020 at 10:01 AM | Permalink


Hi Joe! I've been reading Book of Joe for a *very* long time now. This is the first issue I've ever... well... taken issue with you on.

I agree 100% that manual ventilators work. And that almost anyone can be trained to squeeze a bag 10x a minute. My concern, though, is that when people go down with pneumonia they need to be ventilated for four to six days.

That's a lot of squeezes!

Again, I'm not knocking you for pointing out this solution. But I'm wondering what's the longest you ever had to manually ventilate a patient as an anesthesiologist. Four hours? Eight? Surely not four days non-stop.

Never mind that concerns about aerosolized virus particles from bag-mask ventilators and similar devices were a particular concern in China and Hong Kong since caregivers also had no immunity. That means you probably wouldn't want to stand next to someone and squeezing a bag for them for four days unless you'd already recovered from the illness. Or unless you had some first-rate masks. Some kids at Rice university evidently came up with an automated bag squeezed, though evidently there were concerns about calibrating pressure.

Still. I'm going to agree with you that, as in the video in your first post, if I was a parent of a minor child and they couldn't breathe on their own I'd definitely go to divine, non-inhuman lengths to stay awake and keep them breathing through their endotracheal tube. Not sure I could keep it up for four days but I'd literally die trying.

I'm just not sure you'll find 15,000 volunteers in NYC who would be healthy and able to do that for anyone less than a small child or very much loved parent or spouse.

Posted by: DTI | Mar 31, 2020 9:14:48 PM

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