Thread by @LilRedRooster

I'mma take a second to rant here about the talks I keep hearing about ventilator numbers.

Estimates from the WHO have inpatient requirements currently at 1/5 of those who get sick. Only about 5% of those 20% will need critical care, and not all of the 5% will need ventilators.

Meaning our greatest needs will be in solid med-surg nurses and medical beds, not ICU. The most patients in terms of numbers will be medical, not critical.

The most critically ill with ARDS already have pretty bad outcomes, with a 50-97% mortality once they're on a vent.

The best outcomes, according to what we've seen from other countries, will be to keep the majority of patients OFF vents and OUT of ICU.

That requires solid floor nurses. That doesn't always require machines. That requires solid NURSING skills.

If anything, the discussion around this pandemic has illustrated to me how little emphasis the healthcare profession still places on nursing skillsets to determine the best outcomes. How we automatically focus our discussions on the least favorable life support outcomes.

I had never even heard of non-invasive helmet ventilation until I saw pictures coming from Italy, showing patients lined up in rows with space helmets. No idea what they were, had never even seen one.
news.sky.com/story/coronavi…

Looked them up, and found they had been trialed before with ARDS patients, and found FAR superior to prevent intubation than mask ventilation. nih.gov/news-events/ni…

Why are we not focused on those machines? Ways to prevent ever needing a ventilator? And discussing how absolutely serious needing a ventilator is, and how outcomes don't really improve but actually get WORSE if you end up on that kind of life support?

We need to stop focusing on ventilator numbers and crash courses, and start focusing on preventing ever needing them in the first place, because that produces the BESToutcomes in the MOST sick patients.

Focus on those numbers, and you'll never need the ventilators.