Proud 🤩 to present our preprint on the use of #CO2 monitors in hospital: background, pilot data and protocol for an RCT.
A #COVID19 🧵 @trishgreenhalgh @mjb302
While Belgium is about to become one of the first countries to mandate #CO2monitors in bars, no evidence supports their use, which is particularly problematic in clinical medicine #EBM. How are CO2 levels in hospitals? What does the literature say? @HuffmanLabDU @j_g_allen
Widely varying results have been reported, with values >1000 p.p.m. up to 3000 p.p.m. in low-income setttings vs. excellent values in high-resource settings
@DRTomlinsonEP @ColdProofUK @vanranstmarc @mdc_martinus @PedroFacon
sciencedirect.com/science/articl…
mdpi.com/1660-4601/17/4…
Here's another example of excessive CO2 values which are generally avoided in modern high-resource hospitals
Courtesy @Iamgoingtosleep
@realBertBlocken @CarlvKeirsbilck @CO2meetactie
In two French hospitals, maximal CO2 concentrations of 1121 to 1325 p.p.m. were reported in a hospital nursing care room and plaster room, respectively
@JeroenSchoenm @jeroenbossaert @JochenNijs @Bilulu1 @louis_ide @HarrySpoelstra @DasUlrike
sciencedirect.com/science/articl…
CO2 levels exceed limits when indoor hospital spaces are overcrowded.
In a Taiwanese intensive care unit room, CO2 levels (range 828-1570 p.p.m.) were above 1000 p.p.m. during visitor hours 92% of the year
@GMeyfroidt
ajicjournal.org/article/S0196-…
Another Taiwanese study in 3 hospitals found the worst CO2 concentration on hospital wards (AVERAGE 1063 ± 483 p.p.m.)
@YouAreLobbyLud @k_sienaert
sciencedirect.com/science/articl…
Summary: previous studies have reported widely varying indoor air CO2 levels depending on resource levels, but even in high-income countries, levels >1000 p.p.m. have been reported in hospital rooms, mainly with room overcrowding e.g. visitors
@jljcolorado @DrEricDing @EricTopol
Our RCT aims to provide clinical evidence as to whether provding CO2 monitors in hospital rooms actually improves CO2 levels @OlderTrialsProf
Now some #engineers may think: "wait a minute, isn't that logical... you ask staff to maintain CO2 <800 ppm, what's difficult about that?"
Spoiler alert: Nothing is ever easily implemented in the hospital setting, where we work with PEOPLE.
Any device or peace of equipment is useless without people changing their behavior, opening windows etc. Barriers to improve ventilation are manifold!
@drjohnmorley @wassdoc
One example can be found in our preprint Fig.3B: why do CO2 levels peak up to 1540 p.p.m. around 9 a.m.? 😬
A: Nurses come in the morning to wash two patients, toilet, dress and feed them -doors and windows closed.
Happening in every #hospital everywhere in the world, right now!
Ignorance about this remains astounding.
Most hospitals literally say "our indoor air quality is perfect"
...not based on any actual measurements however. Sometimes measurements are made in the afternoon showing 600 p.p.m., which is what we also found most of the day (Fig. 3B)
So, warning: don't come and B*S* me about how ventilation in our hospital must be awful, and ventilation in your place is perfect. That's probably based on lack of systematic measurements! Previously literature outlined above shows that levels like we found are entirely expected.
To sum up:
1. Now that the #CO2 genie is out of the bottle, it needs to move into hospital infection control.
2. This requires not only #CO2monitors but also implementation science and altering #nursing routines.
Results of our RCT to follow soon!
medrxiv.org/content/10.110…

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More from @MichalLaurent11

20 Dec 20
With 2020 almost over, it's time again to look back at some of the BEST in the #bone field: 🔝20 papers (+extras).

Happy to hear your input! Disclosure: fully subjective ranking!
@ASBMR @AcademyEcts @Osteoporosis_NL @osteoporosisNI @mmse30 @NatalieASims
#1 Atypical Femoral fractures @NEJM (Black DM et al.)
Risk reduces within months of @Bisphosphonate1 discontinuation. Benefit>risk in any group but less so in Asians and women <65yr
nejm.org/doi/10.1056/NE…
-side note- @ECTS_science very useful systematic review and recommendations for managing osteoporosis following AFFs.
ncbi.nlm.nih.gov/pmc/articles/P…

And oral BPs may not only reduce fractures but also cardiovascular events
pubmed.ncbi.nlm.nih.gov/32717068/
@Dr_BoAbrahamsen @prieto_alhambra
Read 24 tweets
30 Aug 20
Every doctor carries along her/his own little graveyard. Inevitably, we make mistakes. People die, or become disabled. You never forget those patients. 1/n
In my first year of training there was a 20yo woman with stage IV lymphoma (DLBCL). She was clinically fine but I overlooked her creatinin which showed severe CKD from diuretics. 1w later she came in with heart block from betablocker overdose and died. 2/n
An older woman during training was admitted after a fall. She complained of shoulder pain -> no fracture. Next day she was paraplegic from spinal fracture. She hadn't complained about her back and I missed that. 3/n
Read 7 tweets

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