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[COVID-19] CPAP use for Coronavirus mitigation & severe pneumonia
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Thanks for starting the post!
There is a "Bleeding edge" post by pulmonary-ER MD suggesting that CPAP (not bi-pap) might be helpful for some COVID-19 patients.
  [link is omitted.  I am not posted before on the Apnea board and apparently am not allowed to include a link in a new post.]
"PulmCrit Wee- Could the best mode of noninvasive support for COVID-19 be… CPAP ??"  (Josh farkas  mar 17, 2020)

One of the comments made that posting notes that the mask exhaler will be shooting out a lot of virus that will be difficult or impossible to filter. Probably want to put a fan in the window and be continually pushing air to the outside.

If any MDs reading this post have useful information, maybe in addition to posting it here, they would also put it on emcrit.org where it is more likely to be seen by medical professionals.

Also, if there ever is a consensus that CPAP would be useful for some people, and CPAP machine shortages develop, most of us will have one or two older machines that could be cleaned and donated.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
I am VERY reluctant to believe that CPAP would be "better than Bi-level" for ventilation purposes.

Simply based upon the pressure support plus the higher pressures delivered (usually 25 cmH2O for Bi-level vs. 20 cmH2O for CPAP/APAP), it would make logical sense that Bi-Level (BiPAP) would act more like the higher-pressure ventilators than regular CPAP or Auto-CPAP.

In addition, for the widest scope of treatment methodologies, BiPAP can be set up to act exactly like a CPAP, thus providing the widest possible range of choices for the care-giver.

If someone has contrary info, please post.
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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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RE: CPAP use for Coronavirus mitigation & severe pneumonia
IMHO the individual situation needs to be evaluated. Pressures and use of EPR, pressure support, and even Flex need to be individually evaluated. The recommendation of 'high' pressure I disagree with because many individuals will suffer from aerophagia which makes ANY treatment difficult, lower pressures are needed to enable any therapy for these users. I also feel that properly applied bilevel can be beneficial because while the average pressure is lower, the higher pressure can be higher if needed.

All CPAPs fall into the NIV, Non-Invasive Ventilation, category. ASV is an advanced system for treating a combination of mixed, obstructive, and central apneas based on maintaining either minute volume or Tidal volume depending on the brand.

Note: Option 1 is always the first and best option and that is to use the Medical System.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Okay, thanks for the link. It makes a lot more sense in context. In post #3 in this thread, I discussed some of the basics of NIV including CPAP, and its role in maintaining positive end expiratory pressure (PEEP). For pneumonia this is essential, so CPAP is certainly applicable to achieve that important objective. What threw me in the summary of the PulmCrit Wee artical was the idea that CPAP improves ventilation, and that is where I would disagree. PEEP is important in lung recruitment, which means, it basically keeps the lung expanded and capable of accepting air, however pressure support, combined with a relatively high EPAP improves ventilation while maintaining volume.

A simple rule of thumb for all ventilation is that PEEP improves oxygenation, while pressure support increases ventilation and flushing of CO2. Generally, we see higher tidal volume with increased pressure support, which in normal individuals can actually reach the point where the respiratory drive is supressed due to loss of CO2 (hypocapnia).

The article suggests monitoring SpO2 (blood oxygen saturation) and using supplemental oxygen ti raise inspired oxygen concentrations (FiO2) in combination with PEEP to maintain lung recrittment as discussed above. All of these are importnt and solid ventilation principles. Pressure support may come into play to assist with the effort of respiration and to increase tidal volume where a person is intolerant of high pressure during expiration. Getting back to your question of how to set up your BiPAP to achieve these goals, CPAP at relatively high pressure is a good way to maintian lung recruitment, but continuing to include pressure support will make that pressure more tolerable, while maintaining the benefits of higher PEEP, and will generally result in a high tidal volume. If you coombine all this with a recording oximeter to evaluate oxygen saturation, then supplemental oxygen could be titrated into the PAP to improve FiO2 and maintain higher oxygen saturation. See the Oxygen Bleed wiki I wrote here http://www.apneaboard.com/wiki/index.php..._with_CPAP
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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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RE: CPAP use for Coronavirus mitigation & severe pneumonia
What is the possibility of using the SoClean equipment with its cleaning abilities to destroys 99.9% of PAP germs, bacteria, and other pathogens?

"Ozone Concentration:

10 ppm @ 5 min when measured 1 cm from the ozone generator output tubing interface on the SoClean device, assuming the starting ozone concentration is < 0.3 ppm prior to turning the SoClean device on."
from the SoClean Manual

Start by removing the Removable Hose Slot Plug, which allows you to set up the SoClean device on either the right or left side of your CPAP machine. Place a new flexible tubing in the Removable Hose Slot Plug. And then the other end of the new flexible tubing to the facial mask being used?

Attached is a rough drawing.


Question is, how long a period of time can a person breathe in the

Left off final question;
How long can a person breathe in the air mixture from the SoClean machine?


Attached Files Thumbnail(s)
   
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Thanks so much for opening this dialogue and offering useful information! I'll stay tuned for more.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
The first time I was in the ICU after my triple bypass (1983), I wanted to use my CPAP but the nurse said "You don't need that. you just need Oxygen", and wouldn't hook it up for me. Well the next night and every time in an ICU since, I have INSISTED on my CPAP WITH AN O2 adapter so they can apply Oxygen when my saturation is low. I can say with experience THIS MAKES THE WORLD OF DIFFERENCE to my breathing, and to my recovery and lung function - even recovering from double Bronchitis.
Please folks learn from this to Stand Up for yourselves - Nurses and Doctors are great, but they can't feel what you feel.
I have adjusted my auto Resmed unit to allow it to auto adjust to it's maximum.
I'm 65, I've got T1 Diabetes, I've got High Blood Pressure, A Mechanical artificial Aortic heart valve, Have an un-healed & extremely painful Sturnum which is stuck to the aorta (and thus can't be opened again), and makes it very difficult and painful to cough.
I think I might be a tad at risk!  Cool
So certainly my preference is to stay at home and use my CPAP with the intention of trying to keep away from the dashed thing.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
On CPAP and COVID19.  It seems to me the wrong question is being asked.>> NOT Can CPAPs serve well for an ICU patient under severe, life threatening  breathing distress,  >> BUT Can CPAPs assist patients to avoid ICU crisis by providing positive pressure, moist air and breathing ease at earlier stages of the illness, allowing  the lungs to better slough off the virus particles and, with better air, oxygen, C02 circulation, provide  more time for the body's antibodies and other defenses  to do be effective  and end teh infection. I believe the answer is YES, providing caution is taken to protect others that are uninfected to avoid  being infected by being near the virus particles that will be in the CPAP exhaust .
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Although we can learn from situations where health care workers in hospitals used CPAP for such purposes, the primary purpose of this thread has always been how patients who are forced to stay at home can use CPAP to their advantage to assist with COVID-19 mitigation, at a time when hospitals become overwhelmed and hospitalization is out of the question due to over-crowding.

It was revealed today that doctors in northern Italy are refusing to admit anyone over the age of 60 to the hospital for COVID-19.  Italy is in VERY bad shape right now.  Those over 60 are all on their own and the hospitals will only work with patients 60 and under, who have the best chance of survival.

When (not if) that same situation arises in other countries, we're going to see that same level of austere triage elsewhere.

Helping ourselves when no one else can is what this thread is all about.  If your local hospital is still able to admit you, then yes, by all means GO THERE if you have COVID-19.

However, when you're turned away due to your age, you have little choice beyond trying to help yourself as best you can where you're at, with what you've got, and THAT is what this thread is about -- a worst case scenario, which seems likely to be coming upon many parts of this world.
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Here's what I have been doing with mine other than for sleeping. I have been on a mobility scooter for 4 years now but I dont let that or the CPAP stop me from doing the activities that I love to do such as camping. With that thought in mind, I still have to be able to use the CPAP when camping. Therefore, I have a deep cycle marine battery, and the cables to connect the CPAP to the battery. So since everything is closed, I have been using the equipment I use for camping and using it for going to where ever I need to go and use the CPAP as a mask, but the mask only covers the nose for me, but I use a scarf and cut the part for the nose out of it and it has worked for me so far. Have got some looks and questions about it. I have the Dreamstation CPAP so it is a small CPAP. The battery is big though, thinking about using a smaller car battery since I am not using it like 8 hours at one time like I would if I was sleeping at a camp site or the like. :thanks:
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