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Comment by didgeoridoo | Hacker News Reader

Ventilating a patient with active pleural effusion (fluid in the lungs) is a finicky process. The vent alarms constantly, and the patient frequently needs to be suctioned, which is a team effort often involving several bedside nurses and a respiratory therapist. Even if we stock up our ventilator supply, I have no idea how we will get enough people to operate them effectively.

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Pleural effusion = fluid around, but not inside of, the lungs. It is treated using thoracentesis. Suction = for removing secretions inside of the larger airways. Consolidation = fluid inside of the lungs, specifically within the alveoli. It prevents oxygen exchange and there is no specific procedure that can address it. Medical management focuses on tricks like proning that can increase ventilation to areas of lung that have less consolidation. If both lungs have consolidation in the majority of lung units, the patient cannot be saved even on a ventilator. In this case ECMO is a possibility, but ECMO resources are very limited and the lungs might not ever recover enough to start working again.

Brain fart — meant pulmonary edema, not pleural effusion. P-E something, anyway.

Thanks for the explanations.

Isn't there a way to oxygenate blood outside of the body like dialysis? Why isn't that used more?

I was wondering this too. It seems like the problem would be the rate of oxygenation of the blood is too high for any current machine to handle and something completely new need to be designed

Great question! You are referring to ECMO. The main limitations of ECMO come from the serious complications that can occur, which can include life-threatening bleeding, blood clots, infections, strokes, and brain damage. The number of hospitals in the US offering ECMO is in the low hundreds. It takes an experienced team to use it safely, and if used in the wrong patients, it can artificially prolong suffering rather than saving a life. However, it is still an amazing technology for some patients.

My spouse is in anesthesia and is currently training dozens of PACU nurses every day on how to operate anesthesia machines and vents for this eventuality. Obviously they won't be providing ideal care, but many hospitals are working on "leveling up" any and all staff that can be trained. Crazy times we're living in.

> I have no idea how we will get enough people to operate them effectively.

Yes, we don't have enough ventilators. But we have more ventilators than what our currently trained staff can operate.

But that isn't a problem that excites engineers.

Actually that seems kind of exciting: making ventilators that don't need highly trained staff to operate. But maybe I'm just weird that way.

But you can’t know what is in another person’s head.

There are some all-in-one ventilators, which automatically suction too, but I guess they are not wide spread:

> VOCSN integrates five separate medical devices, including a ventilator, oxygen concentrator, cough assist, suction, and nebulizer, into one multi-function ventilator.

https://www.venteclife.com

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