The carbon monoxide story. Part 1.2
Continued from Part 1.1
Ludwik: “Its not good enough”
“Why not?”
“Its an n of one”
“The data is indisputable. It shows a marked effect of the hyperventilation.”
“We need at least 5 dogs”
“That’s crazy! One dog shows the principle. Doing 5 dogs gives you an effect size in dogs. We will be treating humans. The effect size in dogs is irrelevant. One dog is good enough.”
“I agree with you Joe, but any journal will insist on a bigger n before they publish.”
“Fine, Ludwik. We will do 5”
“That may not be good enough either. So you show increased elimination rate. People will say, ‘so what? I still need to treat with hyperbaric oxygen’”.
“Ludwik, showing a marked increase in CO elimination is good enough. Even if its less effective than hyperbaric oxygen, its still better than just 100% oxygen which is the standard of care and the best they will get anyway. The vast majority of humanity has no access to hyperbaric chambers.”
“No Joe. We have to do this right and compare the elimination to hyperbaric elimination”
“How the hell are we going to do that???”
It was the afternoon when we anesthetized the dog and exposed it to CO. We were down in the College Street wing basement animal lab facility. About 5:00 p.m., we placed the dog on a patient stretcher. We placed towels strategically under the sheets so that the outline vaguely looked like there was a human body there. We covered the dog with the blanket and ventilated it by hand. We took the elevator up to the main floor and then wheeled it through the corridor and a patient ward and made our way to the hyperbaric chamber facility. Dr. Wayne Evans was in charge of the facility. The last patient had been discharged and Anna, the charge respiratory therapist, had set up the Mohnihan ventilator in the multiplace chamber. I went into the chamber with the dog, turned on the ventilator, dialed in the appropriate settings and attached the circuit to the dog’s endotracheal tube.
Ludwik and Anna closed the doors and began the dive. As we were approaching the 3 Atm depth, the Mohnihan started to get slower and slower. The dog began making ventilatory efforts. Over a short time the dog, who was given enough pentothal to keep it asleep for the next 2 hours or more, began to get light. Its eyes would open a bit; it began to shake its head and move its feet. I shouted through the communications line for more anesthetic. One of the students was sent to the College Street lab to get more anesthetic. But the dog began to move, pulled out his endotracheal tube and was trying to stand up. It was sort of awkward “drunk”and flailing about. One paw got entangled with intravenous and the struggle pulled out the i.v. This was bad: I was in a small chamber with a confused, disinhibited, angry, hurt dog with big teeth. The doors could not be opened because the decompression would have to proceed slowly. Needless to say, we got no data that day.
As much as it caught us by surprise, what happened was actually clear. The Mohnihans were largely prneumatic and the greater density of the compressed atmosphere in the chamber resulted in prolonged exhalation time and slower respiratory rates. And the dog waking up? That was due to “pressure reversal of anesthesia” (Google it). I had read that in medical school but figured “…when will this information EVER be of value to me?” and ‘filed’ it somewhere deep in the brain. I only recalled it when I was wrestling with a crazed dog on the floor of the hyperbaric chamber at 3 Atm pressure thinking “How crazy is this? What the….?”.
Anyway, we figured it out and studied about 5 dogs with our hyperventilation and compared the rates of elimination to 5 dogs treated with hyperbaric oxygen. The results were dramatic, showing that the hyperventilation was as effective as hyperbaric oxygen! Wow! It was published in a fancy shmancy journal. No one—no one!—took any notice.
Read more in Part 1.3
