“Some drops with gravity, some is suspended, and the biggest surprise is the ones that rise … What’s causing it to rise is the (micro) thermal currents.”
WEBSITE: Frank’s Hospital Workshop
EDITOR’S NOTE: Hospital techs have turned to a decentralized information-sharing network to repair essential COVID-19 equipment. Manufacturers have fought to stop them, on the grounds that they’re violating copyright laws.
John Prine died 7 April 2020 from complications of COVID-19 pneumonia. This song from 2018 may seem prescient, but apparently he was simply singing about finding a way to sneak a cigarette. He had quit smoking years ago after contracting throat cancer.
I’ll describe what Gattinoni was saying, which is that really what we’re seeing in ARDS are two different phenotypes: one in which the lungs display what you call high compliance, low elastics; and one in which they have low elasticity and high compliance.
To say it simply for people who are not pulmonologists, if you think of the lungs as a balloon, typically when people have ARDS or pneumonia, the balloon gets thicker. So not only do you lack oxygen, but the pressure and the work to blow up the balloon becomes greater. So one’s respiratory muscles become tired as they struggle to breathe. And patients need pressure.
What Gattinoni is saying is that there are essentially two different phenotypes, one in which the balloon is thicker, which is a low-compliance disease. But in the beginning they display high compliance. Imagine if the balloon is not actually thicker but thinner, so they’d suffer from a lack of oxygen. But it is not that they suffer from too much work to blow up the balloon.
As far as how we’re going to switch, we’re going to take our approach differently from the traditional ARDSnet protocol in that we are going to do an oxygen-first strategy: We’re going to leave the oxygen levels as high as possible and we’re going to try to use the lowest pressures possible to try to keep the oxygen levels high. That’s the approach we’re going to do, so long as the patients continue to display the physiology of a low elastance, high-compliance disease.
GATTINONI LETTER: Am J Resp + Crit Care Med
GATTINONI EDITORIAL: Intensive Care Medicine