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[COVID-19] CPAP use for Coronavirus mitigation & severe pneumonia
#91
RE: CPAP use for Coronavirus mitigation & severe pneumonia
According to available resources, NIV (aka xPAP) is not suitable due to the simple fact fluid builds up in the lungs.  Air can't get in unless you first remove the fluids.  And worse, even if you receive intubation or direct gas infusion into your blood to maintain O2 levels, the outcome is still not good. Brain damage is common.

Everyone should read the Imperial College paper published 20200316:

Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand

Bottom line is that with every measure that is being taken or likely to happen, 80% of the population (specifically UK and US) will be infected within the next 12 months.  

I have a living will that states absolutely no intubation.  Instead, manage pain and let me die a natural death.

I am glad I had this document drafted years ago.  I might need to use it soon.


.pdf   Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf (Size: 715.21 KB / Downloads: 55)

pps: Mother in-law died recently, she was given APAP to maintain her airway her last days, but she had no other lung problems like pneumonia or congestion.  She died shortly after they removed her from APAP.
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#92
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Lots of discussion in the past page about the use of ASV and the relevant studies. They are SERVE-HF and ADVENT-HF. if you are searching. I think the 2015 guidance that restricted ASV for patients with LVEF less than 45% likely deprived many individuals of more effective and gentler therapy, as well as caused many physicians to mis-prescribe ST machines to healthy central and complex apnea patients. I can't wait for it to be withdrawn.

We have a pretty good wiki on using an Oxygen Bleed with PAP (I'm too modest). http://www.apneaboard.com/wiki/index.php..._with_CPAP If you like math, you're going to love it.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#93
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Again, GWild, you may wish to go back and read the entire thread.  We're not talking about what is "Clinically recommended" here.  We're also not talking about what is considered a proven "safe" or "standardized" treatment in a modern medical clinical setting where better alternatives are freely available and plentiful.  Instead, we're talking about "ditch medicine" for a future time when there is no available hospital beds or ventilators and the elderly are simply told "go home and do the best you can" (austere triage) where only the younger with the best chance of survival are put on the limited supply of ventilators.

If a loved one is dying and can't get professional health care, I'm going to everything I can to mitigate their pneumonia and not simply watch them die because some professional scientist in some far-away university had a study that indicates using CPAP for COVID-19 treatment might have some unwanted side-effects.  In other words, we're talking about a dire, worst-case scenario here, not dealing with patients who still have access to traditional modern health care facilities.


Please go back and read my post (HERE), which stated:


Quote:What we're talking about here is helping someone who is on their death bed.  They already have severe pneumonia;  they are going to die without someone stepping up to the plate and thinking of ways to help.  Perhaps methods that modern conventional doctors and hospitals would frown on as being "primitive and risky".

What we're talking about is essentially what war-time medics called "ditch medicine" where they would treat critically-wounded patients as best they could with what they had on hand.  Such war-time medics would need to stop the bleeding in an artery with whatever they could, even if it was an old, dirty rag laying next to them in the fox hole.  They would push the rag into the bullet wound in hopes of stopping the bleeding.  No thought of "hey this rag isn't exactly the preferred method for packing a wound".  No thought of "hey, this rag could give the patient an infection that could severely harm them".   They simply worked with what they had to solve the more critical issue of massive blood loss.  Modern medicine would say "OH NO!  You should only use completely sterile gauze for that!".   But the war-time medic had no such sterile thing anywhere near him and he literally had seconds to get the bleeding to stop.  So he used what he had on-hand.

That's what this thread is all about.   That is my challenge to you-- let's figure out a way that we can use these dirty old rags (CPAP machines) to help in a worst-case disaster scenario.   If we wait to figure this out, people could die who might have been helped by us brain-storming ways in which to adjust our machines to address an off-script use for these machines during this pandemic.

Again, I don't want to argue or disagree.  I simply want us to think how we can use the tools we currently have to do the work that hospitals will be increasingly incapable of doing as time goes on.

Apnea Board's whole purpose is so we can "help one another".  We're not providing medical advice here, especially in this situation of a world-wide pandemic.  The official "medical establishment" is NEVER going to provide insight as to how these machines might help us at home during this crisis.   Or if they do, it will be too little and too late. 

What I'm asking for is not what cannot be done, but what can be done with the limited tools that we have on hand.

We're more like the ill-trained, inexperienced  and frightened army medic who's simply trying to save the lives of his buddies.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#94
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Setting aside ditch medicine, consider also that CPAP might effectively prevent some people from ending up in a critical care setting in the first place.  Since CPAPs are medical devices and cannot be used by people who are merely sick and not in a hospital (except for sleep apnea users), there probably aren't any studies showing whether they are effective at an earlier stage of the disease.
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#95
RE: CPAP use for Coronavirus mitigation & severe pneumonia
I do understand the reason for the thread.  But no one has mentioned the serious issue facing those who seek a hospital bed in the first place:  they can't breathe.  This is most common fluid build up.  How does a CPAP help in that dire situation?  Can it help in that situation?  While if I am in that situation I'll certainly play with settings as much as I can, the physical constraints of non-compressible fluids versus an air-pump are pretty clear.  Maybe if I also had my inversion bed to let fluids drain via gravity?

I tend to be realistic when confronted with inconvenient facts, so I come off as harsh and insensitive.  I'm not.  And let's be clear, I am in the same boat as anyone else who will also need acute hospital care.  And I am all in for asking the question if there are any hidden capabilities in our gear that might be of use in the coming days.
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#96
RE: CPAP use for Coronavirus mitigation & severe pneumonia
@reznik, keeping airways open has helped me when I'd had significant congestion.  Nothing nearing pneumonia, but chronic nasal congestion that would normally turn into a chest infection has been pretty much averted now that I am on PAP.  I still get the drips, but the resulting chest problems have pretty much gone away. 

Anecdotal, but still a data point.

Also, since this will be viral, COMOX won't be helpful.  Here's a piece that discusses home care for pneumonia.  

https://www.lung.org/lung-health-and-dis...overy.html

Anyone have a "last ditch" solution for home O2 generation beyond a PSA or splitting water?  i.e., compressible O2 we can bottle safely.
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#97
RE: CPAP use for Coronavirus mitigation & severe pneumonia
(03-20-2020, 08:28 PM)GWild Wrote: I do understand the reason for the thread.  But no one has mentioned the serious issue facing those who seek a hospital bed in the first place:  they can't breathe.  This is most common fluid build up.  How does a CPAP help in that dire situation?  Can it help in that situation?  While if I am in that situation I'll certainly play with settings as much as I can, the physical constraints of non-compressible fluids versus an air-pump are pretty clear.  Maybe if I also had my inversion bed to let fluids drain via gravity?


Yes, they have mentioned that in prior posts.  Go back and read the entire thread.   We've discussed the issue of fluid buildup.  Even the post I made a few days ago and re-posted again today suggests a possible protocol which includes preventing fluid build up using the prone position method and a PEP device:

http://www.apneaboard.com/forums/Thread-...#pid341045

We're trying to come up with an approach that addresses all of these issues.  It's not simply using CPAP alone.

For the third time, I'll re-post that 7-point protocol here, which is only intended to be a starting point for discussion and fine-tuning, based upon our collective knowledge:

SuperSleeper Wrote:I'm not as knowledgeable as others here on this forum, but I was thinking that if the situation arose where I or a family member got viral pneumonia as a result of COVID-19 and needed ventilation (at a time when hospital care is out of the question due to lack of ventilators), I would do something along these lines:


1.  Turn up the CPAP pressure to the maximum (20, 25, or whatever the particular max pressure for that machine).

2.  If CPAP, turn on the maximum of C-Flex, A-Flex or EPR for comfort when exhaling.  Or adjust EPAP & Pressure Support accordingly for a Bi-level etc.

3.  Monitor blood Oxygen levels with a pulse oximeter on a regular basis.

4. Re-adjust max pressure, perhaps lowering it as long as SpO2 remains at least 92 or higher.  Leave it on max pressure if it's lower than that.

4. Use a full face mask if the pressure is too much with a standard nasal mask or nasal prong/pillows system so that the extra pressure doesn't simply escape out of the mouth while sleeping.  Or use a pretty strong chin strap to keep the patient's mouth closed.

5.
When serious pneumonia comes, stay on the machine 24/7, or as much as possible.

6.  Utilize the "prone position" method when in bed to help with fluid drainage as much as possible. 

7.  If patient is able, use a "Lung Flute" or flutter type PEP device to help break up fluid and assist with productive coughing.  Or use other methods to help with productive coughing.


As always, I'm hoping folks will critique the above approach and add their own comments or suggestions and correct any misconceptions that I may have.

I'd really like us to come up with a standard protocol that people can use in a dire emergency situation when conventional medical help is no longer available.  Again, this is not the best-case scenario-- it's for a situation where we're forced to do the best we can with what we have on hand.

Of course, if Johnny Lee comes up with a way to modify the mechanics of a CPAP machine to force breathing with timed pressure increases, that might be better, but in the mean time, most people aren't going to have the mechnical skills to do what he is doing and will need simple advice on how to use their CPAP machine as-is to help with pneumonia as best they can.
[Image: thinking-about.gif]
SuperSleeper
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#98
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Well, if CPAP won't help when there's fluid, how would a ventilator help?  Neither actively remove fluids.
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#99
RE: CPAP use for Coronavirus mitigation & severe pneumonia
I continue to believe that if there's a role for CPAP, its in helping people to breath *before* they become critical and need hospital treatment.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
(03-20-2020, 08:40 PM)Reznik Wrote: Well, if CPAP won't help when there's fluid, how would a ventilator help?  Neither actively remove fluids.


Bingo.  Both CPAP use and ventilator use needs to be supplemented with methods to help remove fluid in the lungs.  We're not talking about using CPAP alone in this thread.  We need a complete protocol for emergency use only, and that protocol would likely include a variety of pneumonia-fighting tools, including possible CPAP usage.

Coffee
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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