The Futility of Doing More Research on Oxygen to Save Lives
The Futility of Doing More Research on Oxygen to Save Lives
Extreme Forced Oxygen - Part 3 - The latest and greatest treatment for respiratory viruses
See part 1 and part 2, the article continues below the links.
I looked at 2 research papers from 2023 on the topic of High Flow Nasal Therapy. In my last post I wrote about a paper that was published in BMJ by the WHO.
This post will be on the subject of the other one which was published in the Annals of Intensive Care.
The Annals of Intensive Care received an H-Index of 78 from SJR.1 It ranks number 4 out of 16 journals on the listing for Critical Care Journals on Google Scholar.2 It appears to have a good reputation to me.
Here are some highlights from the paper published by The Annals of Intensive Care3:
“The effectiveness of high-flow nasal cannula oxygen therapy (HFNC) in patients with acute respiratory failure due to COVID-19 remains uncertain.”
“In patients with acute respiratory failure due to COVID-19, HFNC reduced the need for intubation and shortened length of stay in hospital without significant decreased risk of mortality.”
“We identified a total of 22,080 studies using our search strategy. After removing 12,669 duplicates, 9411 titles were screened, out of which 398 full-text articles were assessed for eligibility.”
“20 studies were retained in the analysis for the main and secondary outcomes, including 6 RCTs (2509 patients), 5 prospective observational studies (3944 patients) and 9 retrospective observational studies (1930 patients)”
“In the trial sequential analysis, the futility boundaries were reached, suggesting that HFNC is unlikely to have an effect on mortality and that the addition of more trials would not modify the conclusion”
“HFNC was associated with lower risk of intubation and reduced length of stay in hospital without any effect on mortality as compared with COT. Our findings support the routine implementation of HFNC in patients admitted to the ICUs for acute respiratory failure due to COVID-19”
My thoughts on this:
This research paper identified 9411 titles. That is almost 10,000 studies on the use of HFNO. This indicates to me that a lot of people want to find a different result than what they keep finding. They are repeatedly testing this protocol, and not finding what they are looking for.
This paper suggests there is futility of doing more research on this protocol in terms of having an effect on mortality. It does mention that there are more studies to be done regarding other aspects of the protocol.
This paper is recommending HFNO as a protocol to get people out of the hospital, but it does not claim that HFNO is saving anyone’s life.
Almost 10,000 studies into this treatment looking for something that apparently they cannot find, that it saves lives, would you even be able to get a paper published that questioned it as a protocol?
It sounds like COVID-19 was an excellent opportunity for researchers to get grants and money for research.
🤔
High Flow Nasal Oxygen therapy does not appear to affect mortality.
It reduces the need for ventilation, but it does not affect mortality.
It reduces time in the hospital but it does not affect mortality.
Overall the consensus is that it does not affect mortality, in other words it does not save lives. Regardless of this being stated in many studies , it is still standard of care for COVID-19 and other respiratory diseases.
According to many studies this protocol helps to keep hospital beds empty, while it does not affect mortality. The studies suggest that it is not killing anyone, nor is it saving anyone.
I find it perplexing. I am not seeing much benefit, for the COVID patients receiving this treatment. I am seeing a benefit for the hospitals in terms of freeing up beds. I am seeing benefits for investors who have made the right investments, such as investing in corporations like Fisher&Paykel, manufacturers of the Airvo2.
In 2 future articles I will share 2 stories, one about a person who was treated with it, and how it did not save her life. In fact she was tortured by it. And another with a more positive ending.
The state of "health" care presents a bewildering scenario. It may prove challenging to grasp the full picture when one is a doctor amidst these events.
Personally, this situation does not inspire confidence in seeking testing to find out what kind of a cold I have. It does inspire me to eat healthily, exercise, get rest, and spend more time in nature.
In my opinion, this is a deeply troubling issue. More to come in the next article.
High-fow nasal cannula oxygen versus conventional oxygen therapy for acute
respiratory failure due to COVID-19: a systematic review and meta-analysis
copy paste to see the paper : https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-023-01208-8
It would be easy to do a controlled study. Hook 100 doctors to the high flow oxygen, another 100 are the control group who are not hooked to high flow oxygen.
I was half-expecting to learn the "extreme forced oxygen" (High Flow Nasal Therapy) to be found to cause lung damage due to pressure exerted by "extreme forcing." Apparently not...
Although your conclusion that economic forces rather than reduced mortality inspires hospitals to use HFNT seems quite valid, given the dangers of being hospitalized with covid, I'd be relieved to be discharged even one day sooner from an institution that reaps $10k or more for each covid death recorded.