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New blogpost: silent hypoxemia in #COVID19 and avoiding intubation. It's not just podcasts and Twitter threads any more: we have published papers calling for early & abundant O2, awake proning, and CPAP in silent-hypoxemic COVID-19 patients.

srconstantin.github.io/2020/05/04/sil…
Italian ICU that uses helmet CPAP as first-line for severe COVID-19 has half the death rate of US ICU (in Seattle) that uses invasive mechanical ventilation for all severe cases. 24% vs 50%. Similar disease severity at admission.
Simple suggestion by NYC emergency physician Richard Levitan: get a pulse oximeter at the drug store. Check yourself BEFORE you have trouble breathing. If people with asymptomatic hypoxemia get prompt oxygen therapy, they might never progress to severe disease.
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Sarah Constantin
@s_r_constantin
ahajournals.org/doi/pdf/10.116… This is an interesting theory as to why "silent hypoxemia" is a thing in #COVID19
Ordinarily, when not enough oxygen is getting to (parts of) the lung, due to lung damage (as from pneumonia), there's a thing called hypoxic pulmonary vasoconstriction. Arteries pumping blood to fucked-up alveoli become narrower, so more blood can pick up oxygen from good alveoli
This is called ventilation/perfusion (V/Q) matching. Failure is called V/Q mismatch. You have blood flow without oxygen, or oxygen without blood flow.
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Sarah Constantin
@s_r_constantin
Derek Lowe is always the high-quality skeptic on all things pharma, and that’s a valuable role. Still, I feel like this isn’t really engaging with the issues: blogs.sciencemag.org/pipeline/archi…
“Clinical trial regulations are completely unnecessary & don’t improve the quality of research at all” is a strawman. There might be some that are absurd, but in general, these rules are made by smart people, for actual reasons.
Yes, CGMP rules ensure pure & stable drug samples. Yes, rigorous study designs make study results more credible. The question is: how much more credible, relative to the cost?
Read 14 tweets
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Sarah Constantin
@s_r_constantin
is there a keyword for "line by line going through a process and trying to evaluate which steps can be cut without damaging the outcome?" is there a science of this?
if it's a cooking recipe, you just try skipping a step and observe if it ruins the dish. for more expensive or risky projects, you sometimes can't actually run that experiment. ("what happens if you skip this safety step at the nuclear reactor?")
but even nuclear reactor designers need to control costs. so I wonder how they streamline things. Asking the relevant experts "ok so what happens if we don't do this step? with what probability?"
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