Can "Liquid Breathing" help?

[mabartha]

From the limited news I have heard about the worst-case Coronavirus symptoms, the lungs seem to fill with fluid making the ventilators not work effectively enough. Why not avoid aggravating the lungs by "working with" the symptoms by filling the lungs with high-Oxygen liquid? I had heard that Liquid Breathing is used in neonatal using PFOs. Otherwise, can we look at supersaturating water (or another common liquid) with Oxygen like we use in Agriculture (CO2Gro or Moleaer)?

What am I missing, other than actual medical knowledge (a large gap in itself) with this as an option?

[Nikhil1213]

In fact, these liquids carry more oxygen and carbon dioxide than blood. In theory, liquid breathing could assist in the treatment of patients with severe pulmonary or cardiac trauma, especially in pediatric cases. Liquid breathing has also been proposed for use in deep diving and space travel.

[Paxiled]

You have actually hit on something that is being found by physicians working on this problem.  A physician in Italy, I believe, one of the hardest hit countries, has written a published paper that putting covid patients on ventilators may well be what is killing many of them.  The ventilators are designed for lungs that are stiff and hard and push a lot of air into them.  Covid patients have perfectly fine lungs, soft and flexible, but filled with a virus, and the ventilators aren't designed for that.  What these doctors are finding, and I have seen some in New York interviewed now as well, is to try as hard as possible to keep the patient breathing on their own as much as possible, and giving them oxygen in less intrusive ways than a ventilator and turning the ventilators down if they do go on them.  Now, this is practitioner data, not double blinded scientific studies. but these doctors are reporting lower death rates by doing it this way.  The death rate on a ventilator is around 80%.  They are reporting much better than that by keeping as many folks off of them as possible.  So your methods might not work, I have no idea,. but your idea appears to be right.

[Student_of_Knowledge]

I heard a similar testimony from an English doctor. She claimed that the symptoms resembled altitude sickness, and that it was almost as if the patients had been suddenly moved to the top of a mountain. According to her, the ventilators only increase the pressure on the lungs which speeds up the deterioration of the lungs and is causing more deaths. While I’m commenting I might as well add that although this pneumonia treatment doesn’t seem to work for covid - the only method I have heard works (according to a survivor) is inhaling from a chopped onion. A survivor wrapped the chopped onion in a cloth and kept it on her chest which she says helped her recover from what were life-threatening symptoms.

[AnnieBrooke]

What you might be missing is that by the time someone is on a ventilator, their lungs are full of fluid, and there would be no way to replace one liquid with another (saturated with oxygen or not). As it is, it is apparently very difficult to aspirate fluids out of the lungs enough for the oxygen from the ventilator to make its way in.

[mabartha]

I understand that as the conversation goes on, more details may be found to shut my thoughts down. However, staying optimistic for the sake of continuing the conversation, we've noticed with these methods in agriculture that the oxygen actually spreads through the water extremely well and fast, and doesn't need to be physically moved when the bubbles are small enough. We aerate a single 500k Gallon silos and the oxygen can move within a few days to 4 other 500k Gallon silos without need for pumps.

Would the diffusion of Oxygen between the newly introduced saturated liquid and the already existing fluid be potentially prohibitive and really need to be replaced?

[AnnieBrooke]

You are thinking about attempting to pump into lungs (that are full of liquid and detritus) a different liquid that includes oxygen? It might come to pass some day; the research articles about the technique you are describing do say one hoped-for future use is treating ARDS (acute respiratory distress syndrome). Evidently it's in the experimental stages. One problem named is that creating a ventilator that could precisely introduce (oxygen-saturated) liquids into degraded lungs with precision is apparently more difficult than building ventilators that pump oxygen. But it might happen some day. (If I can find articles about it on the Internet, someone is working on it.)

[Paxiled]

But do keep in mind, the lungs are not degraded with the corona virus.  They are sickened but not long-term degraded.  It's one of the problems reported by physicians who have decreased the use of ventilators and decreased mortality as a result, they claim.  The lungs of a corona victim are still quite supple.  People are walking into the hospital talking and functioning just fine but when measured they have very low oxygen levels.  This isn't what happens in typical pneumonia or other lung disorders.  

[AnnieBrooke]

Just today, Dr. Fauci was talking about the realization they are coming to in doing autopsies and analysis (very new) that the people who get a sudden crash are getting it not so much because their lungs are full of detritus but because their blood won't intake the oxygen it has available. This might be related to the fact that the virus apparently causes a lot of clotting, or possibly because it does something else to the blood. Evidently even if the lungs are working (to some extent), the oxygen is simply not going into the bloodstream. So possibly they will find the the analysis they do when this virus is finally managed, that the lungs were not the biggest problem in the chain.  

[mabartha]

Correct AnnieBrooke, I was basically thinking of getting the saturated liquid into the lungs (like pouring water down a straw that is already sitting in water) to connect the two fluids and hope that the barrier between the fluids is not opposite in some way like oil and water. I also didn't think of the issue you mentioned of difficulty getting the fluid into the lung as it would have a potentially worse pressure effect than air currently is doing. Nevertheless, of course this doesn't work if the blood doesn't take up the oxygen available to it. I don't have anything to say to that except for full sci-fi options.

From what I heard (before Dr. Fauci announced about this) is that the suspicion of the clotting was that it exacerbated the underlying potential issues with high pressure, the heart or other issues that can cause clotting. The new announcement changes things.

Thanks for the info everyone. It was very informative and interesting to read.

[AnnieBrooke]

There is also a method they can use in emergencies that involves putting oxygen straight into the bloodstream, but apparently it is only a short-term thing (like 15 minutes) for stabilizing a patient, such as, a drowning victim. But if they do decide there is something to this notion that when someone is very ill with Covid it is partly because the blood doesn't uptake the oxygen correctly, maybe they will look again at that method and try to figure out how it can be done over a longer period of time.

[Paxiled]

I think they are doing this.  There's a machine that removes the blood from the patient and the machine oxygenates it and then they put it back.  But let's all not get to that point, fingers crossed.

[AnnieBrooke]

That sounds like the machine I had read about, an extracorporeal membrane oxygenation (ECMO) machine. It oxygenates the person's blood outside the body, brings it back to body temperature, and puts it back into the body, which seems in line with the original poster's question about why we can't just put the oxygen right into the blood.

The article I originally read that mentioned ECMO machines seemed to imply that they are more complicated (or rarer?) than ventilators, and could only be used for about 15 minutes at a time. But tonight when I was looking for the name of the machine, I ran across an article about someone with Covid-19 who was on an ECMO machine for apparently more than a day. Clearly they are being used, and not just for 15 minutes. I assume that if ECMO machines became the machine of choice over ventilators, there would become a shortage of ECMO machines like happened with everything else. But if the problem is really that when someone has an acute case of the coronavirus, the blood for some reason becomes unable to uptake oxygen by itself, this might be a smarter way to try to keep someone alive than by pushing oxygen into the lungs. (God forbid we should have to find out.)

[Paxiled]

I'm guessing these folks are probably on ventilators already.  To be so ailing as to need this they are probably in an induced coma on a ventilator and then they do this.  But of course I'm not sure about this.

[AnnieBrooke]

I asked a childhood friend who is now a heart doc about the ECMO machines, telling her that it seemed from what I was reading that there was a constraint about using them, but that they kind of sounded good, so what was the story? Here's what she said.

"ECMO is like a heart-lung bypass machine.  It takes a gazillion people to run it (perfusionist, respiratory therapist, one-on-one nursing, physician -- all fully dedicated to that one patient).  There is a theory that Covid causes hemolysis (broken blood cells) and that may be the mechanism of cell destruction. Since red blood cells carry oxygen, using ECMO (extracorporeal membrane oxygenation) gets more O2 into the body. It was used fairly extensively during SARS -- we had a bunch of patients at our hospital who were on it.  It's just so personnel-intensive that not everyone can be on it.   Not sure how they make the decisions about the ECMO lottery, but I suspect the young and healthy get priority. I read about a 49 y.o. attorney (no underlying health problems) who was intubated and in a medical coma for 42 days (including ECMO), but made it home eventually."

[Paxiled]

I don't think there are a whole lot of these machines available at any one hospital, as well.

[AnnieBrooke]

From what she described about the ICUs in New York, four people or more dedicated full-time to one patient is the impossible part.

[AnxiousNoMore]

The doctors have experience with ventilators so I'm sure they will figure out the best approach if you end up needing one. Since you don't have experience with ventilators, it is unrealistic to think you can figure out a unique solution to deal with Covid.

[mabartha]

And often when you are in the thick of things, you can't afford to step back and see other options. I understand that in an emergency like this, they can only work with the technology that exists in the medical field but I'm curious if other industries have already managed to break through aspects that could help in future issues similar to this one.

[GuitarRox]

I agree with you AnxiousNoMore.  The fear initially was that they didn't know how to best treat people and I do think they still grapple with that.  But at this point, there are results to deal with that doctors are sharing.  Your question mabartha is a good one.  Countries do need to be sharing best practices with true analyzed information.  I am sure some hands on learning has been happening when some technique may be 'discovered'.   There is a specialty in medicine in which the sole purpose of the doctor is to map out treatment for various disorders, how to use equipment, etc. in order to teach other doctors and come up with protocol for best practices.  I think we'll begin to have a more clear picture with more innovation with covid-19 as time goes on.  We have to, right?