Deltex Medical Share Discussion Threads

[nobbygnome] 07/4/2020 10:03

I can imagine buywell frantically googling to try to counter schloo's points! However, there won't be any satisfactory answers for him....

[nobbygnome] 07/4/2020 08:56

A post from schloo on the other DEMG thread. It highlights what a disgraceful troll buywell is. It is time for him to stop spreading misinformation...

>>buywell3

You are making it up again

We have been through your pathetic fictions about an ODM probe being dangerous several times before and you have been shown up for a total idiot even from the references you yourself tried to con people with

Of course you can use an ODM probe with a ventilator. You put it in before you inflate the cuff as part of the intubation process. If you need to add one later, to help save the patient, you deflate the cuff and place the probe and then re-inflate it

Lidco, Edwards, Pulsion (and Deltex) all offer the ability to monitor cardiac output from arterial blood pressure sensors (called PPWA). The only validated intervention is through the minimisation of respiratory swing through either Pulse Pressure Variation (PPV) or Stroke Volume Variation (SVV). Respiratory swing is an artefact of being on a respirator/ventilator. To be valid:

- patient must be 100% mechanically ventilated, i.e. no spontaneous breathing. Most doctors would much prefer their ICU patient to be breathing spontaneously as much as possible to avoid becoming ventilator dependent and reduce the risk of ventilator associated pneumonia

- the tidal volume on the ventilator must be at greater than 7ml/kg so you need to be aggressively forcing air into the lungs to see the impact on the arterial pressure trace reliably. In the last few years it has become increasingly clear that ventilators are dangerous to patients if the tidal volume is not 6ml/kg or less

- so, in practical terms, there are close to zero patients in ICU with CoVid 19 where the doctor can really sort your fluids out with PPWA, although it is a useful tool to detect big picture changes. By contrast, ODM works on everyone at all ventilator settings because it actually measures blood flows from the heart, aka cardiac output

I would suggest that, if you knew what you were talking about, which you clearly don't, and someone you cared about was in ICU with CoVid-19:

- you should be appalled if they were not using any cardiac output monitor to guide fluid management

- you would pleased if they were using PPWA from any of LID, DEMG, Edwards Lifesciences or Pulsion but quite worried in case they weren't using it safely, for example if tidal volume was either too low too high or if the patient was in part breathing spontaneously, even though that would be good news for their survival prospects

- you would be delighted if they were using ODM

There is a very good reason that ODM has cornered the market in clinical evidence over the last 25 years: it works

I really, really think you should go back and delete all the fictitious nonsense you have been posting and shut up

Schloo

PS as for why DEMG might be lending monitors free of charge:

1. its their way of clapping the NHS
2, its their business model anyway

[nobbygnome] 07/4/2020 08:54

It is good to hear from someone who knows what he is talking about. Buywell is essentially a troll who deliberately spreads misinformation. It is absolutely disgraceful and he should be ashamed of himself. However, sadly leopards don't change their spots so I won't hold my breath for any humility....

[schloo] 07/4/2020 08:41

>>buywell3

You are making it up again

We have been through your pathetic fictions about an ODM probe being dangerous several times before and you have been shown up for a total idiot even from the references you yourself tried to con people with

Of course you can use an ODM probe with a ventilator. You put it in before you inflate the cuff as part of the intubation process. If you need to add one later, to help save the patient, you deflate the cuff and place the probe and then re-inflate it

Lidco, Edwards, Pulsion (and Deltex) all offer the ability to monitor cardiac output from arterial blood pressure sensors (called PPWA). The only validated intervention is through the minimisation of respiratory swing through either Pulse Pressure Variation (PPV) or Stroke Volume Variation (SVV). Respiratory swing is an artefact of being on a respirator/ventilator. To be valid:

- patient must be 100% mechanically ventilated, i.e. no spontaneous breathing. Most doctors would much prefer their ICU patient to be breathing spontaneously as much as possible to avoid becoming ventilator dependent and reduce the risk of ventilator associated pneumonia

- the tidal volume on the ventilator must be at greater than 7ml/kg so you need to be aggressively forcing air into the lungs to see the impact on the arterial pressure trace reliably. In the last few years it has become increasingly clear that ventilators are dangerous to patients if the tidal volume is not 6ml/kg or less

- so, in practical terms, there are close to zero patients in ICU with CoVid 19 where the doctor can really sort your fluids out with PPWA, although it is a useful tool to detect big picture changes. By contrast, ODM works on everyone at all ventilator settings because it actually measures blood flows from the heart, aka cardiac output

I would suggest that, if you knew what you were talking about, which you clearly don't, and someone you cared about was in ICU with CoVid-19:

- you should be appalled if they were not using any cardiac output monitor to guide fluid management

- you would pleased if they were using PPWA from any of LID, DEMG, Edwards Lifesciences or Pulsion but quite worried in case they weren't using it safely, for example if tidal volume was either too low too high or if the patient was in part breathing spontaneously, even though that would be good news for their survival prospects

- you would be delighted if they were using ODM

There is a very good reason that ODM has cornered the market in clinical evidence over the last 25 years: it works

I really, really think you should go back and delete all the fictitious nonsense you have been posting and shut up

Schloo

PS as for why DEMG might be lending monitors free of charge:

1. its their way of clapping the NHS
2, its their business model anyway

[nobbygnome] 07/4/2020 08:10

I doubt we will get anything before the results towards the end of this month.

[chrisdgb] 07/4/2020 07:52

Would be nice to have a COVID 19 update, highlighting this.......

[ramnik007] 07/4/2020 07:05

But Deltex tech does not require pipe insertion into oesophagus. However the option exists when deemed required by clinician. As has already been highlighted by Nobby, in another post, it has the most flexible set of options available to clinicians.

[buywell3] 06/4/2020 21:43

''The need for mechanical ventilation in those who are critically ill is high ranging from 42 to 100 percent''

A cuff balloon seals off the esophagus around the breathing tube so that the mechanical ventilator can function properly

Any pushing of a probe down the esophagus after the patient is on a ventilator could at best compromise the effectiveness of that seal , whether the ODM probe was inserted down the nose or throat. At worst it could puncture the balloon cuff and break the seal thus stopping the ventilator working.

Masks are used with mechanical ventilators thus preventing ODM probe insertion after the patient is on intubation ventilation via a mechanical ventilator , ''The need for mechanical ventilation in those who are critically ill is high ranging from 42 to 100 percent''.
.
As to other types of ventilation see this link




" NIV – If NIV is initiated, a full-face mask rather than a nasal or oronasal mask is preferred to minimize particle dispersion.''

NIV is Non Invasive Ventilation

" The mask should preferably have a good seal and not have an anti-asphyxiation valve or port. "

also an oronasal mask is mentioned in that link and CPAP
A CPAP machine uses a hose and mask to deliver constant and steady air pressure.

here is what one looks like


''Precautions — Intubation is the highest risk procedure for droplet dispersion in patients with COVID-19 [27]. The following discussion is suitable for patients outside the operating room (eg, intensive care unit [ICU] and emergency department) (table 2).''

putting a ODM probe down a patients esophagus is intubation

intubation
/ɪntjʊG2;beɪʃ(01;)n/
Learn to pronounce
nounMEDICINE
the insertion of a tube into a patient's body

all IMO do your own research
you need to

DEMG are having to offer their monitors free of charge to the NHS now , why ?

[nobbygnome] 06/4/2020 20:15

Extremely good news. DEMG should benefit more than LID from the ongoing crisis....yet compare the market caps and the relative price action. DEMG is a clear buy IMHO....

[toninosc89] 06/4/2020 20:11

I am not a medical expert. Is that a good or bad news?

[nobbygnome] 06/4/2020 18:44

Plus on the 6 o'clock news they just had a piece from an ICU at UCLH where they were using ODM on ventilated patients in the background! No LID kit in sight....

[nobbygnome] 06/4/2020 18:41

I asked Andy Mears about the use of ODM in ventilated patients and contrary to the information put around by some LID muppets it can be used very successfully! I paste the relevant paragraph from his email below.

'The ODM works very well in the ventilated ICU patient. We have 22 RCT’s showing outcome benefit and all of those were completed on the ventilated patient, one of those being post-op in cardiac intensive care. We will not be used on every patient, but should be used on the really sick ones with sepsis and ARDS.'

[nobbygnome] 06/4/2020 16:10

But they are cashflow positive so cash should be fine!

[euclid5] 06/4/2020 16:09

Reading the last trading statement, think they are getting low on cash imo:

Cash on the balance sheet at 31 December 2019 was £0.9 million

[chrisdgb] 06/4/2020 12:10

Indeed, still think we will get a bid for this company in the next year, closer to 3p.......

[toninosc89] 06/4/2020 12:03

Let's go up to 2p+ !!!!

[74tom] 06/4/2020 11:47

Yes, thanks for the heads up here! Was very surprised to see that it had retraced back from the 2p+ from a couple of weeks ago...

[nobbygnome] 06/4/2020 11:44

All buys so far (despite the assigned designation) so primed to take off IMHO. The MMs are so twitchy on this stock...

[chrisdgb] 06/4/2020 10:56

Totally agree, it would be so nice to actually hold our gains one day......

[nobbygnome] 06/4/2020 10:53

About to take off again; there isn't much stock available on the RSP. The value discrepancy with LID is complete madness and the bears assertion that the monitor won't be used in ventilated patients is completely wrong as usual. What they forget (or never knew in the first place because they are ill informed) is that you can do multiple different sorts of measurements on the DEMG monitor including what the Lidco system does. Essentially it is a much more flexible and advanced bit of kit!

[mrc2u] 06/4/2020 08:55

ByeByeWell you surpass your own extraordinarily high standards of idiocyAside from the fact that Doppler probes have been used safely in hundreds of thousands of intubation patients over more than 20 years, have you 'thought' about applying your made up gibberish to nasogastric tubes? Do all people on a mechanical ventilator eventually starve to death?You really should get out moreMrC

[buywell3] 05/4/2020 02:36

That little audio video link in the forbes link above shows a balloon being inflated in the Esophagus to seal it , so that the mechanical ventilator can work properly

So how do you clever people on the DEM other thread think that a probe can go by the balloon without upsetting how the mechanical ventilator works properly ?

Remember the patient is sedated and the ventilator is doing the breathing for the patient, the lancet says:

Staff safety during emergency airway management for COVID-19 in Hong Kong

''Medical professionals caring for patients with coronavirus disease 2019 (COVID-19) are at high risk of contracting the infection.1 Aerosol-generating procedures, such as non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), bag-mask ventilation, and intubation are of particularly high risk.''

''Once an endotracheal tube is inserted, its cuff should be inflated immediately to avoid leakage. The endotracheal tube should be connected to the ventilator via a filter and a waveform capnography monitoring device, with ventilation only started after pilot balloon inflation is confirmed.''




Hopes this helps re Covid-19 and probes

The balloon seal required ,for the mechanical ventilator tube just above the esophagus branch to the lungs , in order for the ventilator to operate correctly does IMO inhibit the use of additional probes ,

Note : Also intubation is seen as 'high risk' for staff in the lancet link above.

The insertion of a probe down a patients Esophagus is an intubation
Intubate: To put a tube in



buywell awaits to be proved wrong by Deltex putting a Covid -19 guidance on how to use their probes on patients in ICU's on ventilators .

If one is forthcoming then apologies will be made and my recent posts deleted

IMO Covid-19 has given LiDCO the distinct advantage because it can be used without interfering with ventilator intubated patients

dyor

[buywell3] 04/4/2020 23:55

Read this ....... just appeared on LiDCO websites (they have two)

'' We are also working closely with government agencies and couriers to monitor the situation and make contingency plans to ensure we can deliver products.''

LiDCO now working 24/7 to meet demand







A message to the healthcare providers we support around the world.

We know that with the complex and ever-changing COVID-19 outbreak, you are concerned about protecting the health of your patients and your employees.
We too recognise our responsibility as a medical device manufacturer to support the medical community.

We are prioritising our activities so that you can feel confident in our ability to support you during this situation.

Our operations teams have been working additional hours including the weekends to maintain continuity of supply and service.

Our customer service teams are able, if it becomes necessary, to work remotely to support your requests. We are also working closely with government agencies and couriers to monitor the situation and make contingency plans to ensure we can deliver products.

We have taken steps to ensure that our employees understand and follow preventative measures recommended by local health authorities and the World Health Organization (WHO).

We have implemented employee travel restrictions and postponed events.

However, our representatives and clinical teams are here for you and want to help you in whatever capacity you need.

Finally, thank you for your efforts at this challenging time -You are all heroes to us!

The LiDCO Team
---------------------------------------------------------------------------------


Re ventilators

A non rebreathing mask is used

What is a non-rebreather mask?

A non-rebreather mask is a medical device that helps deliver oxygen in emergency situations. It consists of a face mask connected to a reservoir bag that’s filled with a high concentration of oxygen. The reservoir bag is connected to an oxygen tank.

The mask covers both your nose and mouth. One-way valves prevent exhaled air from reentering the oxygen reservoir.

A non-rebreather mask is used in emergency situations to prevent hypoxemia, also known as low blood oxygen. Conditions that disrupt your lungs’ ability to uptake oxygen or your heart’s ability to pump blood can cause low blood oxygen levels.



So where does the Deltex probe go ?

[gbenson1] 04/4/2020 17:54

Nice to see on the news that the government had ordered a supply of evasive and non-evasive ventilators, does this play into DEMG hands? Any doctors or medical staff throw any light on this?