Warrington hospital's high survival rate -are other hospitals doing this?

[lightlypoached]

Saw this news article where Warrington hospital has been using a modified sleep apnoea machine instead of ventilation. It seems to work more efficiently, avoids ventilation and is much cheaper. Added bonus is that machines are faster to manufacture too.

www.warrington-worldwide.co.uk/2020/04/23/warrington-hospital-leading-the-way-in-cutting-covid-19-death-rates/

I read this on Sky news a couple of days ago. I thought the results they’re seeing are really positive. It seems a pretty simple way of helping people breathe and less intrusive than other methods and as you say cheap too.

Yes other hospitals are doing this. Ventilation is the last resort.

They've only modified the machines to take oxygen. All they're doing is using CPAP. CPAP/BiPAP will always be considered before ventilation in any critical care situation. Ventilation is always a last resort.

It may be behind Germany's survival rates, early simple oxygen for as many people as possible

I wondered from the beginning if people received oxygen help early on whether it would cut the proportion of people deteriorating to the point where a ventilator was necessary to keep breathing. Given the whole ' stay at home and don't burden the nhs' though, I quickly realised that the NHS had no interest in finding out if that was the case. I am pleased some hospitals are investigating this. Also I thought they WERE using normal home CPAP machines , So I am really surprised that the report seems to suggest this is unusual.

Instead of investing in so many ventilators, might it not make sense to lend these machines for home.use for short periods of time when someone is strut to breathe but maybe not bad enough to go to hospital.

Yes other hospitals are using CPAP. Most hospitals have more CPAP machines than ventilators so it's a no brainer.
I have a colleague who was on ICU with covid and he is now at home recovering with a home CPAP machine. He and his wife are both consultants so I don't know if patients are widely being sent home on CPAP or whether it's because of who they are but at least it frees up an icu bed for someone else.

CPAP/BIPAP for respiratory issues isn't a new thing it's been used for years. It is seeming that some people's outcomes are better for it for covid but then that would be true for other respiratory symptoms too.

Ventilation isn't always the answer for lots of reasons. It's not a pleasant thing to put the body through. It's still the last resort. People aren't taken into hospitals and put straight onto one. It's the last chance.

For example my mum had COPD she slept upright and had CPAP to sleep at night and o2 in the daytime. We were told in her 50s ( a good few years before she passed away) her lungs and body wouldn't cope with ventilation. She was always treated in hospital but with CPAP and antibiotics as the highest point of care.

I work with Paeds patients that have CPAP at home too due to chronic lung disease.

THis isn’t shocking as the issue with CV patients is a VQ mismatch (ventilation/perfusion). Splinting the airways open with CPAP helps this, as done proning patients (laying them on their front).

As I understand it, what's different about Warrington is that there are only a few CPAP machines in each hospital so they are still used as a last resort type intervention. Whereas these black boxes modified with proper masks and oxygen are relatively cheap and easy to get hold of, so hospitals are able to use them at a much earlier stage. It's the earlier intervention that leads to a much reduced death rate. Which is why this country's don't come in until your blue and fighting for life strategy is actually causing death rates to be much higher than they need to be.

I read an interesting article comparing the symptoms of cv to altitude sickness rather than pneumonia and also to high levels of co2 being an issue. Thus early oxygenation is a good thing and ventilation not so good as that itself causes a build up of co2?

Warrington’s death rates are half those of surrounding similar size towns too so perhaps they have been doing something differently.

Yes, I read about this a few days ago. Getting in there early and slightly but not intrusive ly aggressively is making such a big difference to outcomes.

If this is picked up on and replicated in the long term, then it could make a big difference for patients in care homes, community hospitals and so on. Much better if they can be treated before damage to the Airways is done, and less likelihood that they'll need to be moved.

That sounds really promising. My dad has one those machines for his snoring.

Funnily enough one of our consultants developed a cpap mask using a snorkel mask from a well known french sports retailer, a valve that we use on cpap machines and a plastic connector that was produced locally via a 3d printer. The great thing about it is that it uses a relatively low flow of oxygen so reducing aerosol transmission.
We have had quite a few patients discharged to the ward who used this and never progressed to full ventilation. So really positive news too and something that we could actually use in the future !

And getting these patients to lie on their front really helps too, something we only ever used to do on heavily sedated patients.

I have also thought that people with breathing problems are sometimes seen too late , struggling to breathe must take a huge toll and deterioration can be rapid . In fact I worry far more about being denied oxygen than needing a respirator

@Hermanhessescat where are you?

That sounds brilliant. God bless the people on the front line who are basically having to invent their own ways of treating it.

Thanks stuckindoors. Not so far from Warrington actually. We were all a bit when he brought it into work but its actually been one good thing that’s come out of this - far more comfortable than the usual crap masks so patients tolerate it better !

As I'm reasonably close to Warrington hospital (close enough to try to get there under my own steam if I needed hospital treatment) I'm hoping that these "inventions" will spread to nearby hospitals fairly quickly.