Sunday, March 28, 2021

Non-invasive suport for COVID breathing difficulties

The treatment of COVID patients can create its own difficulties and problems. A treatment that is now avaiable reduces some of those difficulties: Helment ventilation. The study below shows that it can be used with no loss of efficacy

Effect of Helmet Noninvasive Ventilation vs High-Flow Nasal Oxygen on Days Free of Respiratory Support in Patients With COVID-19 and Moderate to Severe Hypoxemic Respiratory Failure

Domenico Luca Grieco et al.

Question: Among patients admitted to the intensive care unit with COVID-19–induced moderate to severe hypoxemic respiratory failure, does early continuous treatment with helmet noninvasive ventilation increase the number of days free of respiratory support at 28 days as compared with high-flow nasal oxygen?

Findings: In this randomized trial that included 109 patients, the median number of days free of respiratory support within 28 days was 20 days in the group that received helmet noninvasive ventilation and 18 days in the group that received high-flow nasal oxygen, a difference that was not statistically significant.

Meaning: Among critically ill patients with moderate to severe hypoxemic respiratory failure due to COVID-19, helmet noninvasive ventilation, compared with high-flow nasal oxygen, resulted in no significant difference in the number of days free of respiratory support within 28 days.


Importance: High-flow nasal oxygen is recommended as initial treatment for acute hypoxemic respiratory failure and is widely applied in patients with COVID-19.

Objective: To assess whether helmet noninvasive ventilation can increase the days free of respiratory support in patients with COVID-19 compared with high-flow nasal oxygen alone.

Design, Setting, and Participants: Multicenter randomized clinical trial in 4 intensive care units (ICUs) in Italy between October and December 2020, end of follow-up February 11, 2021, including 109 patients with COVID-19 and moderate to severe hypoxemic respiratory failure (ratio of partial pressure of arterial oxygen to fraction of inspired oxygen ≤200).

Interventions: Participants were randomly assigned to receive continuous treatment with helmet noninvasive ventilation (positive end-expiratory pressure, 10-12 cm H2O; pressure support, 10-12 cm H2O) for at least 48 hours eventually followed by high-flow nasal oxygen (n = 54) or high-flow oxygen alone (60 L/min) (n = 55).

Main Outcomes and Measures: The primary outcome was the number of days free of respiratory support within 28 days after enrollment. Secondary outcomes included the proportion of patients who required endotracheal intubation within 28 days from study enrollment, the number of days free of invasive mechanical ventilation at day 28, the number of days free of invasive mechanical ventilation at day 60, in-ICU mortality, in-hospital mortality, 28-day mortality, 60-day mortality, ICU length of stay, and hospital length of stay.

Results: Among 110 patients who were randomized, 109 (99%) completed the trial (median age, 65 years [interquartile range {IQR}, 55-70]; 21 women [19%]). The median days free of respiratory support within 28 days after randomization were 20 (IQR, 0-25) in the helmet group and 18 (IQR, 0-22) in the high-flow nasal oxygen group, a difference that was not statistically significant (mean difference, 2 days [95% CI, −2 to 6]; P = .26). Of 9 prespecified secondary outcomes reported, 7 showed no significant difference. The rate of endotracheal intubation was significantly lower in the helmet group than in the high-flow nasal oxygen group (30% vs 51%; difference, −21% [95% CI, −38% to −3%]; P = .03). The median number of days free of invasive mechanical ventilation within 28 days was significantly higher in the helmet group than in the high-flow nasal oxygen group (28 [IQR, 13-28] vs 25 [IQR 4-28]; mean difference, 3 days [95% CI, 0-7]; P = .04). The rate of in-hospital mortality was 24% in the helmet group and 25% in the high-flow nasal oxygen group (absolute difference, −1% [95% CI, −17% to 15%]; P > .99).

Conclusions and Relevance: Among patients with COVID-19 and moderate to severe hypoxemia, treatment with helmet noninvasive ventilation, compared with high-flow nasal oxygen, resulted in no significant difference in the number of days free of respiratory support within 28 days. Further research is warranted to determine effects on other outcomes, including the need for endotracheal intubation.


Media Cartel Bill Is Bait and Switch to Strangle Conservative Outlets

The Journalism Competition and Preservation Act (JPCA) is a bait-and-switch attempt that claims to help conservative news sources but would instead purge them from the marketplace of ideas, and Congress should reject it for the freedom-killer it is.

JCPA would give media companies—broadcast and print—an exemption from federal antitrust laws, so they can operate in a coordinated fashion to negotiate prices that social media companies like Facebook would have to pay them to carry their content. It would ensure that these tech billionaires would have to direct some of their riches into content providers.

But that’s a Big Boys’ game where the major players could decide who to let into their club. Smaller outlets would be left out in the cold, and the market would suffer.

This is because almost all of the Big Boys are liberal. For print, there’s The New York Times and The Washington Post. For video content providers, you have the networks, CNN, and MSNBC. The twin star performers owned by News Corp—Fox News Channel and the Wall Street Journal—are some of the only ones to the right of the 50-yard line.

The bill’s supporters say it would help small, conservative outlets like the one you’re reading now. No chance. I talk almost daily with friends on Capitol Hill, and I heard from them the names of a couple of hard-charging right-wing outlets who were supposed to be the beneficiaries of this legislation. But then I talked with the CEO of one of those companies and found out that no one had approached him on this bill before it was rolled out. (And for that matter, he opposes it.)

Aside from having done thousands of interviews over the past half-century, I used to be part owner of some radio stations and know how the media industry works. The reality is this: Media companies prefer cartels and monopolies, just like many other businesses.

This provides them a chance to have one without the lean and hungry conservative happy warriors. Offer a bill with the sales pitch that it will protect those citizen journalists, then have the big dogs circle the wagons on terms that the social giants must meet for huge corporations, but then keep those citizen journalists outside the circle.

That’s what this is—a classic bait and switch. News Corp would be fine under the JCPA and with it all of that company’s conservative voices. But there are as many moderates at Fox News and the Wall Street Journal as there are conservatives and more than a few liberals. Facebook couldn’t turn those outlets away, but that company might be the only right-of-center media company at that level. It would effectively give Fox and the Journal a monopoly on news that is not hard-left, which means that “conservative” would be whatever the Murdoch family says it means. People who get all their news from social media—and there’s an increasingly high number of those—would never hear voices like the ones who they are accustomed to reading at this outlet.

So JCPA would allow the liberal big media company to have a cartel with only one non-liberal company. All the plucky, intrepid conservative outlets could form their own cartel, but it would make up such a small slice of the media pie that social media could ignore them altogether.

If Facebook has to negotiate on a rate to carry news from outlets that are stridently conservative, they would just let the conservative outlets name a price—any price—agree to that price per piece, then rarely or never take any of their pieces. In theory, everything is okay because they have an agreement, but the big tech titans would just never pick up any content under the agreement.



"Absolute power grab": Democrats' election overhaul extends far beyond ballot box (Washington Times)

Benefiting from chaos: Insurance companies, reaping shareholder benefits from protests, get in line with Black Lives Matter (Free Beacon)

Who actually wears the pants: White House elevates VP with "Biden-Harris Administration" directive in public communications (Washington Times)

Friendly fire: Democrat breaks with House Speaker Nancy Pelosi on push to overturn Iowa election (Examiner)

GOP mounts defense against DC statehood as bill gets House hearing (Examiner)

Sidney Powell, who totally missed the forest for the trees, seeks dismissal of Dominion lawsuit (The Hill)

U.S. Treasury sanctions two top Chinese officials for "serious human rights abuses" of Uyghur Muslims (Daily Caller)

What a novel idea: Army pulls the pin on "gender-neutral" combat fitness test, creates separate tiers for men and women (Washington Times)

America last: Americans wait for COVID vaccines as U.S. commits millions of doses for neighboring countries (Fox News)

The data shows lockdowns end more lives than they save (NY Post)

Morgan Stanley requests employees fulfill "diversity" quota in job application process (Daily Wire)

Deloitte tells employees "microaggressions" are considered a punishable offense (Daily Wire)

Forty-five black intellectuals demand Smith College apologize to workers wrongly accused of "racial profiling" (National Review)

Policy: Earmarks represent corruption, waste, and The Swamp. Keep the ban in place. (Daily Signal)

On second thought... Majority of voters now want to finish Trump's wall as crisis intensifies (Washington Times)

Administration expelled just 13% of nearly 13,000 family members in past week (Axios)

Non compos mentis: Biden still hasn't nominated commissioner for agency that oversees the border (Examiner)

Montana governor understandably threatens legal action if feds fly migrants from southern border (Examiner)

BLM anarchists mob store in Rochester, New York, trapping 100 customers inside (Daily Wire)

Church of England may impose ethnic quota for clergy (Disrn)

Pandemic unemployment benefits fraud could top $200 billion (Fox Business)

Policy: The everything bubble: How a debt-driven economy creates more frequent crises (Mises Institute)

Double standards: Press Secretary Jen Psaki's sister gets cushy government job despite Biden's "no family members" pledge (National Pulse)

Once held hostage by teachers unions, West Virginia just passed the nation's broadest Education Savings Account program (The Federalist)

As predicted, a significant 5.6 percentage point increase in homeschooling rates in Fall 2020 (

Virginia, with second-most executions, outlaws death penalty (AP)

Workers file 684,000 jobless claims, fewest since the pandemic began (NY Post)

Illinois state senator who sponsored "no cash bail" law upset that man who threatened him with a gun was released on $,1500 "affordable bail" (TTAG)

Kamala Harris to discuss "empowering women" with womanizer Bill Clinton (White House Dossier)

Policy: Abolish the corporate income tax (City Journal)

Bump stocks not "machine guns" and not subject to ATF ban, federal appeals court rules (Washington Times)

Arkansas dignifies women, bans biological men from female sports (UPI)

Washington state to automatically restore voting rights for people on parole and probation (Axios)

San Francisco school board, which wasn't satisfied with her attempts to make amends, strips VP's title after anti-Asian tweets surface (Fox News)

Irony: Abe Lincoln statue vandalized by Black Lives Matter activist in Boise, Idaho (Daily Wire)

USC reaches $852 million sex abuse settlement involving former doctor and 710 female victims (UPI)

High school cancels teacher after she accurately disputes cause of George Floyd death during class (Disrn)

Parler says it repeatedly warned FBI about violence planned for January 6 (Daily Caller)




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