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[COVID-19] CPAP use for Coronavirus mitigation & severe pneumonia
RE: CPAP use for Coronavirus mitigation & severe pneumonia
(03-21-2020, 03:47 PM)SuperSleeper Wrote:
(03-21-2020, 03:35 PM)seth Wrote: My only question: How much should I change these settings, if necessary?

(03-21-2020, 03:37 PM)abworld Wrote: I have a basic question:  What should the settings for a Bipap machine be in an emergency life-threatening pneumonia situation such as this?  -Thanks!


Hi Seth & abworld, this is exactly what this thread is hopefully going to accomplish.  Basically a standard protocol for adjusting our machines at home to act more like a ventilator, in a way that does not bring about more negative consequences over the positive ones.

Of course, supplemental supplies & equipment would have to be used in addition to CPAP when possible.


To repost a couple of examples from crowtor's post (HERE) and my post (HERE), this is just a start:


(03-20-2020, 05:51 PM)crowtor Wrote: As far as I know the current proper ARDS protocol is:

1.low Tidal volume ventilation(invasive)
2.laying on the stomach
3.paralysis(injection) to comply with the ventilator.

Omitting the last one, the first 2 are somewhat achievable on our machines.

My source: https://youtu.be/okg7uq_HrhQ?t=306
Other more scientific source: https://youtu.be/14NbqW_xf2U

Regarding CPAP's and BiPAP's in context of ventilation http://www.anaesthesia.med.usyd.edu.au/r...ation.html


and


(03-18-2020, 06:19 PM)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.

Thinking-about


I'm hoping others can take what was said in the above quotes and fine-tune things with a bit more detail for us.

Coffee

I forgot to add but bronchodilators could be of potential use during an emergency, even if someone has no asthma or COPD, which alot of us do have.

As for the air filtration part. I do think that if one person is sick then anything other then a 'clean room' type of setup with negative pressure would be pretty much useless. Considering that a sick person cant feed themselves, I think it's safe to assume if one family member is sick, all of them are or will be sick.

Having said that you could potentially tape all the mask/hose vents and use a hose adapter with a standardized opening to vent the air and put a standardized filter on it, really easy to design, just gotta know what type of filter would suffice. These adapters can be 3d-printed from anywhere. Such a mask could be further 'sealed' with a few smears of platinum-cured silicone. You could also put a UV diode at the outlet to further enhance it(maybe even power it from the heated hose circuit), that would however require some form of air flow to ventilate the ionised air out of the room.

There's also the possibility of using a copper solution as a disinfectant. I have not researched about the claims yet. Here's a video: https://youtu.be/a1DK_1DthyM

Another adapter(for a real filter) at the inlet of a cpap so the machine itself isnt contaminated could also be an option, Airsense 10 devices can be modified like that, dunno about the others.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
(03-22-2020, 09:33 AM)crowtor Wrote: As for the air filtration part. I do think that if one person is sick then anything other then a 'clean room' type of setup with negative pressure would be pretty much useless. Considering that a sick person cant feed themselves, I think it's safe to assume if one family member is sick, all of them are or will be sick.


I suppose that's true in a lot of cases.  Just thinking about this, I would think it also depends upon how "socially engaged" the infected person had been prior to them being isolated, and how much they were touching things around the house and interacting with household members when they were infected but asymptomatic.

But yeah, I get it that there's a real risk that anyone in the household of a COVID-19 patient will be exposed eventually, no matter what precautions are taken.

That's one of the reasons why it would be important for any caregiver to use as much PPE as possible when taking care of the patient, taking extreme care not to become infected themselves.

I'm certain that my "poor man's example" of rigging up a negative pressure room with an open window & fan is certainly not ideal, but may provide some degree of help.

The point being is that the deck can be stacked in our favour to some degree, although removing all risk is near to impossible.

Another point-- While we can't reduce all risk, what we MIGHT be able to do is delay the sickness for other household members.  In other words, "flattening the curve" for our own household, so that ALL members of the household don't  get sick all at the same time.  By trying to space out who gets sick, that will leave at least one person who can act as a caregiver for the other sick members.  Then when (hopefully) they recover, they can in turn act as caregiver for a family member who gets sick at a later date.  

Our "home methods" probably need to mimic the same concepts as what's going on with "social distancing" on a grander scale in our various localities.  Spacing out the infections is important because of limited supplies & equipment, but also because of limited healthcare workers who can easily become overwhelmed with too many sick patients all at one time.  If everyone in a household comes down with COVID-19 all at once, that's worse than having it spread out, so one person is severely sick this week, and then they get better and can help with others who get sick next week.

Great input folks.  Let's keep the ideas coming.

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SuperSleeper
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
If you look at the ventilator machines used in the hospitals, they essentially supply clean air and oxygen to patients.  They cost $6,000 to $45,000.  It is estimated that we need an additional large number (25,000) of theses machines within the next months with currently insufficient capacity to produce them.  I propose that ASV Auto CPAP machines IN conjunction with an oxygen concentrator and antibacterial/viral filter could be used to treat patients at home.  I thought this was an original idea but I just learned China is using this technique to send people home earlier from hospitals. I hope somebody on this forum can get this idea out to CPAP/Oxygen Concentrator manufactures and policy makers as it has the potential to save lives and treat patients after they get home from the hospital.  The CPAP side of this configuration in conjunction with antibacterial/viral filter could be used where ventilator machines are not available in hospitals.  It would be better than nothing and could save lives.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
(03-21-2020, 04:20 PM)josephanzel Wrote: Do people with sleep apnea fall in a more risky group if they get infected with sleep apnea? is sleep apnea a chronic disease?

SWAG: Scientific Wild mAsk Guess. 

Yes, apneacs are probably less healthy in general. 

There's probably no data yet on that specific question vs. COVID-19.  i.e. Take an apneac and an equally healthy* non-apneac.  Does the apneac have a higher risk of infection or serious complications? 

*Not sure how you would measure "equally healthy." 

We probably have a higher risk of not receiving proper care if we end up in a hospitals.  Many doctors and nurses will say you don't need your CPAP if you're on oxygen, which is patently insane.
Get the free OSCAR CPAP software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Some interesting numbers based on an article:
Www://sccm.org
Society of critical care medicine
United States resource availability for COVID 19

Covid 19 pandemic projections
NB I have rounded to simplify
--------------------------------------US----------------------- Canada
Population. 331,000,000------ 38,000,000------ Source: worldometer
30% test positive. 99,300,000-------11,400,000
5% hospitalized. 4,965,000------------ 570,000
40% admitted to ICU. 1,986,000--------------28,000
50% required ventilator. 993,000-------------114,000

Supply of ventilators:
Full featured. 62,000
Less 46% peds. (29,000)
older ventilators. 98,000
less: NIV. 22k
Resusicator 32k
CPAP. 9k. (63,000)
Strategic national stockpile. 13,000
Total ventilators. 81,000. 2,723

Now maybe the peds units could be used for adults and maybe the resusitators could be used but even so, it is very obvious that there is a serious shortfall.

Even the number of ventilators for both countries is highly questionable. Different news sources give different numbers

Even if those 81,000 ventilators could service 4 patients ..... that still leaves more than half of the patients SOL.

For Canada, I got the number of ventilators from a local news source, but they had no numbers for Ontario. For Ontario, they are being coy and not disclosing the numbers. I found a study that outlined the number of ventilators but it was a few years old. Even if Canada has 5,000 (a number I have heard tossed about) that still only addresses 20,000 patients (with the 4 to 1 technique). In absolute numbers less than the US but percentage wise ....... way, off the mark.

Then added to the issue is the lack of suffient intensivists. US 29,000 but 48% of the hospitals have 0. Then nurses, technicians, etc. And having the right number in the right place at the right time.

If the curve could be slowed down and spread over a year or more, and all other factors coordinating perfectly maybe we could make it.
Sleep-well
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
I Found a link on buying a used oxygen concentrator.

https://easyoxygen.com.au/blogs/articles...ator-think

For those of us who can't remember the 60's it is going to take a couple of weeks to get hold of one, what with prescriptions, transport holdups and maybe a service. Plus a few thousand dollars.
And an oxygen nipple adapter, tubing etc.

It's a risk verses reward strategy.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Hopefully this is not redundant since I read Post 6 and numerous other posts, of which some provide information close to the information found at McGill University's Critical Care Medicine Teaching File: "Preventing intubation in acute respiratory failure: Use of CPAP and BiPAP"  which is quite extensive (too much to paraphrase here) but for those interested in its context and it can be found here:
https://www.mcgill.ca/criticalcare/teaching/files/intubation
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
My question about settings for emegncy BiPAP use pertains solely to an absolute dire life threatening emergency, Covid-19 induced pneumonia. Scenario is the patient either cannot get hospital ventilation, or needs ventilation treatment before getting to a hospital, IE in-home emergency ventilation with a home-grade apnea machine (ResMed, Respironics, etc). I am not knowledgeable in Med-speak, nor are many apnea sufferers, so laymans' language is helpful. Again, what would appropriate home apnea- BiPap machine settings need to be in this emergency setting?  What would the Emergency Settings be for these parameters below (& please, assume I & others do not even know what these settings refer to!) ->
 -EPAP min & max. (Expirtory Positive air press)
 -PS min & max. (Pressure support)
 -BPM (Breaths per min.)
 -Ti. (Inspiratory time)
 -Tidal volume.

Also, I saw a reference recommending the patient be prone to help drain the lungs- please explain.

& Biiig Thanks for all you do!
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Looks like we are on the right track.     Some adapters may be available soon.
Take a look at WSJ article called "Israel Turns to Its Spy Agencies to Combat Coronavirus"

(as a non-acrive user I can not post real the link  ->  www wsj com / article / israel-turns-to-its-spy-agencies-to-combat-coronavirus-11584735025 )

To help meet demand, a team in Israel’s military intelligence branch known as the Technological Unit, or Unit 81, is working with medical professionals to upgrade household BiPap ventilators, which help patients with sleep apnea and other breathing difficulties, into hospital-quality ventilators.

“A prototype is being manufactured in the unit at this moment in order to study it and bring it to wide use,” the Israeli military said in a statement.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Re: filtration or sterilization of expiation air , what we use in our water filtration business, besides chlorine, is germicidal or UV-C  lamps (wavelength of 254 nm). It may take some McGyver skills to prevent the UV from being too close to the patient, but I think it is doable.

BTW, thanks to all for this thread and specially to the mods. I have thought about this for a week now, and it's good to hear that others have the same ideas.
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