Influenza Pandemic Will Pose Tough Choices for Use of Mechanical Ventilation

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Amidst all the talk about the risk of an influenza pandemic, little has been said about the difficult decisions that would have to be made in an overwhelming health care crisis. An article in the February issue of Academic Emergency Medicine, the Official Journal of the Society for Academic Emergency Medicine, outlines a sample set of guidelines for prioritizing the use of a piece of equipment likely to be in short supply in a pandemic: mechanical ventilators.

''The more antibodies, the better. But even at lower levels, there is a possibility of protection, '' Goodman said. Despite its limited effectiveness, the vaccine still could prove better than nothing in an outbreak, said Norman Baylor, director of the vaccine office at the FDA, according to the AP. ''The benefit of having a licensed vaccine against a potential pandemic influenza virus strain must be weighed against the risk of having no vaccine at the time of an inevitable influenza pandemic, '' Baylor told the advisory panel. flu strain.

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Biscuit Root, Pungent Desert Parsley, arid climates in the northwest. Its large root has given it the name ''biscuit root.'' This plant has traditionally been used to fight many infectious diseases, of both bacterial and viral origin, particularly those of the lungs, such as tuberculosis. Lomatium was used in the southwestern United States during the influenza pandemic of 1917 with reportedly good results.

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Drs. John L. Hick and Daniel T. O'Laughlin of University of Minnesota propose a concept of operations and a set of suggested guidelines for triage of mechanical ventilators in a pandemic or bioterrorist attack. "When a large-scale pandemic does occur, we're simply going to run out of resources," comments Dr. Hick. "We need to be talking now about how we are going to allocate scarce resources to the patients most likely to benefit from them."

Even today, there are conflicting estimates of how many deaths the great influenza pandemic of 1918 caused worldwide. In 1927, an American Medical Association study set the total at a conservative 21 million. Some say it was closer to 100 million. In the U.S. alone, where the disease is generally believed to have originated, approximately 675, 000 citizens died.

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Even when the flu does not reach pandemic proportions, it is the source of misery, illness, and death every flu season, which runs roughly through the fall and early winter months in North America. Since the early 1970s, researchers estimate that influenza has caused more than 40, 000 deaths in the United States every year (Dushoff J et al 2006). It is estimated that flu outbreaks cost about $12 billion annually in the United States (Kasper DL et al 2004).

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Drs. Hick and O'Laughlin developed their proposal after a recent drill showing that an epidemic affecting ten percent of the Minneapolis area would lead to a "rapid and critical shortfall" in the supply of mechanical ventilators. "Despite a surge capacity of between 2,500 and 3,500 beds in the area, there were 16 ventilators available in our regional system," says Dr. Hick. industrial petroleum products
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The proposal calls for a set of general guidelines to be developed in advance by a team of public health officials and medical experts. The guidelines would be subject to review by a separate group, including elected officials and members of the public. petroleum products
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The guidelines would be arranged in tiers-as resources are exhausted, another, more stringent set of criteria would come into effect. At each level, the criteria would be based on clinical indicators of the patient's chances or survival and likely use of health care resources, with the objective of directing scarce resources to the patients most likely to benefit. rubatex msds
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In a crisis, the guidelines would rapidly be tailored to the specific situation, then issued as part of an emergency order. "The goal would be to promote consistency between hospitals and regions," says Dr Hick. "Across the board, resource allocation would be as equal as possible. The concept is distributive justice-doing the greatest good for the greatest number of patients." rubatex pipe
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In Minnesota, the process is underway, according to Dr. Hick. "A set of general guidelines has been developed by a science team and vetted by a guidelines review group. Reception has generally been very positive, including discussions of the ethical issues involved with community groups." rubatex 180
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Even more important than the specific plan that emerges, Dr. Hick believes, is the establishment of a decision-making process. "We need to start talking about this now and develop a fair process so that, in a crisis, a mechanism is in place to apply the best science we have to make the best use of the available resources. Although our plan is not definitive, we hope it will serve as the starting point for a discussion that needs to be had." rubatex 1800

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