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Comment by popotamonga | Hacker News Reader

Can you actually buy a consumer ventilator? I would see myself paying up to 10k for a ventilator to have at home just in case...

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If you're so sick you need a ventilator, you're also going to need a ton of supportive care as well.

The chances of a ventilator being the one missing link between life and death (outside of a hospital) is pretty small.

The chance of it being the missing link within a hospital seems large though. I imagine there are more beds then there are ventilators in any given hospital.

So the plan is to keep one around the house, maintained in good condition, to take with you to the hospital?

And if the staff is t trained on that particular model, there is no way they’ll use it.

No. The current survival stats involve 20% of those infected ending up in ICU. If this was to become a pandemic that would require millions of respirators to maintain that survival rate. Think about that and what "condition" you would accept for a respirator.

A cpap, or especially s bipap will come pretty close. Not the same in that isn’t true life support, but it does make breathing _much_ easier.

I use a cpap at home for sleep apnea and was on a bipap for about 48 hours when hospitalized for pnuemonia.

Machines cost about $500-1500 dollars. Do require a percription though.

CPAP is a good way to prevent someone from getting intubated later on. It doesn't reduce the risk entirely, but early and aggressive CPAP usage can definitely reduce the likelihood of a pt needing intubation further down the line (more common w/ asthma/COPD, but there is some evidence supporting its use w/ ARDS pt's as well)

In not sure this is true. CPAP/PEEP are used for first line mild ARDS. But it seems hard to find any conclusive evidence for efficacy. It definitely makes people more comfortable, but it's hard to say if the clinical efficacy is really there.

The evidence is stronger in the case of mild ARDS (early NIVPP reduces intubation rates), by the time it has progressed to moderate/severe ARDS, it's too late and NIVPP isn't going to do any good.

Apologies that I'm on my phone right now and don't have links at hand, but I have done some reading on this topic recently.

Outside the edit window, but this is one of the studies I was referring to: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057073/

From the conclusion:

> Intubation rates did not exceed 35% in non-ARDS and mild ARDS and NIV may thus be used as the first-line ventilatory support ... By contrast, 84% of severe ARDS required intubation and NIV does not appear beneficial in this subset of patients ... In patients with moderate ARDS, NIV may be worth attempting in those having a PaO2/FiO2 ratio >150 in the absence of hemodynamic instability or altered consciousness ...

There are definitely significant shortcoming to that study (single facility, etc), but it definitely points in the direction of CPAP being a viable treatment, especially if it's used aggressively (initiated early, high PEEP, etc)

CPAP makes inhaling easier, but it makes exhaling harder. Some CPAP devices have a setting that drops the pressure when exhaling, but not all of them do.

CPAP devices don't require a prescription to buy in many places around the world. You can easily buy them online, and setting the pressure is very easy on many models. A prescription could be useful for figuring out the pressure you need, but it's pretty common for people in countries with shitty healthcare systems to just buy a machine and self-titrate.

In the case of ARDS (which is what the sickest coronavirus patients end up with), it's actually that expiratory pressure that's important (you wouldn't want to configure the CPAP to drop the pressure on exhalation).

With ARDS the lungs fill with fluid, which causes the little sacs in the lungs (where gas exchange actually happens) to collapse and 'stick' closed. The higher 'baseline' pressure[1] helps keep them open.

[1] This is known as "PEEP" or "Peak End Expiratory Pressure", i.e. the pressure in the lungs at the end of exhalation. For ARDS/pneumonia patients, you want high PEEP.

You used to be able to buy high quality CPAP machines on Amazon. I don't see them any more.

There are also streamlined processes to get the prescription. You take the machine home over night and they monitor your breathing remotely.

Years ago I successfully argued with a CPAP company about their jacked up rates and was able to find the exact same CPAP machine for about 1/3 the cost.

Good to know that I can also use it for a pandemic. ;-)

10k for the ventilator is on the low side, but assuming you could buy one you still need an ICU or rough equivalent to take care of everything else and a massive autoclave for periodic sterilization or you're going to get a nice infection on top of your already very bad air supply situation. This is well outside of DIY territory, though there are people living in 'Iron lungs' for decades (but those are typically strong enough to survive for a while outside of them and can breathe independently if they have to, they use the iron lungs for relief).

Would you also hire a respiratory therapist on retainer to operate it for you?

Probably better to hire one to train you in it’s operation.

My wife is ICU medic

Not sure what you mean by "medic" in this case, but does she have much experience running a vent? ARDS requires very careful management of ventilator settings (in addition to a whole host of other care), and is typically handled by specially trained respiratory therapists in a hospital setting.

Doing this could deprive hundreds of people of a life saving device.

If it’s on the open market it’s presumably not saving any lives.

If it does get to the point where we have to pull everything off the open market, then maybe, but you can always go and offer it to a local hospital.

Prices and consumption signal producers the relative importance of a good. Its better for people to drive prices up so suppliers can respond appropriately.

Right now it makes sense for instance for defense companies (eg large manufacturing corps) to partner with med corps (who's supply chains are in shambles) to start cranking these our.

But they won't unless the profit/market is there for it.

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