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[COVID-19] CPAP use for Coronavirus mitigation & severe pneumonia
RE: CPAP use for Coronavirus mitigation & severe pneumonia
On 4. I would boil the tap water (I have a plug in electric kettle for when I can’t buy distilled water locally, such as now).  There are often/always? chlorine-resistant organisms in your drinking water/taps which are fine for your gut, but not so much for your nasal passages, I think they have a more direct path to your brain.  Just like for a neti pot.  There are not that many cases each year, and fatality varies by location, but I think it’s best avoided...
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Hi there

This is about lying on face to help :


medicalxpress. com/news/2020-03-wuhan-lying-severe-covid-. html

Wuhan study shows lying face down improves breathing in severe COVID-19
by American Thoracic Society
 
Credit: CC0 Public Domain
In a new study of patients with severe COVID-19 (SARS-CoV-2) hospitalized on ventilators, researchers found that lying face down was better for the lungs. The research letter was published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.
 
In "Lung Recruitability in SARS—CoV-2 Associated Acute Respiratory Distress Syndrome: A Single-Center, Observational Study," Haibo Qiu, MD, Chun Pan, MD, and co-authors report on a retrospective study of the treatment of 12 patients in Wuhan Jinyintan Hospital, China, with severe COVID-19 infection-related acute respiratory distress syndrome (ARDS) who were assisted by mechanical ventilation. Drs. Qiu and Pan were in charge of the treatment of these patients, who were transferred from other treatment centers to Jinyintan Hospital.
A majority of patients admitted to the ICU with confirmed COVID-19 developed ARDS.
The observational study took place during a six-day period the week of Feb. 18, 2020.
"This study is the first description of the behavior of the lungs in patients with severe COVID-19 requiring mechanical ventilation and receiving positive pressure," said Dr. Qiu, professor, Department of Critical Care Medicine, Zhangda Hospital, School of Medicine, Southeast University, Nanjing, China. "It indicates that some patients do not respond well to high positive pressure and respond better to prone positioning in bed (facing downward)."
The clinicians in Wuhan used an index, the Recruitment-to-Inflation ratio, that measures the response of lungs to pressure (lung recruitability). Members of the research team, Lu Chen, Ph.D., and Laurent Brochard, Ph.D., HDR, from the University of Toronto, developed this index prior to this study.
The researchers assessed the effect of body positioning. Prone positioning was performed for 24-hour periods in which patients had persistently low levels of blood oxygenation. Oxygen flow, lung volume and airway pressure were measured by devices on patients' ventilators. Other measurements were taken, including the aeration of their airway passages and calculations were done to measure recruitability.
Seven patients received at least one session of prone positioning. Three patients received both prone positioning and ECMO (life support, replacing the function of heart and lungs). Three patients died.
Patients who did not receive prone positioning had poor lung recruitability, while alternating supine (face upward) and prone positioning was associated with increased lung recruitability.
"It is only a small number of patients, but our study shows that many patients did not re-open their lungs under high positive pressure and may be exposed to more harm than benefit in trying to increase the pressure," said Chun Pan, MD, also a professor with Zhongda Hospital, School of Medicine, Southeast University. "By contrast, the lung improves when the patient is in the prone position.
Considering this can be done, it is important for the management of patients with severe COVID-19 requiring mechanical ventilation."
The team consisted of scientists and clinicians affiliated with four Chinese and two Canadian hospitals, medical schools and universities.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Hi all,

Tis is about COVID 19 symptoms

Loss of smell could reveal hidden virus cases: experts
 
Credit: CC0 Public Domain
 
From a mother unable to smell her baby's nappy to a lawmaker who suddenly could not taste food, some coronavirus patients have described a loss of olfactory senses—and experts say this might be a new way to detect the virus.
 
Ear, nose and throat (ENT) specialists in Britain, the United States and France have noted a growing number of patients in recent weeks with anosmia—the abrupt loss of smell—and have said this could be a sign of COVID-19 in people who otherwise appear well.
 
Official figures suggest the coronavirus has infected some 380,000 people as the pandemic proliferates around the world, but with many cases going undetected experts have become concerned about the potential for people without symptoms to spread the virus.
 
The World Health Organisation lists the most common signs of COVID-19 as fever, tiredness and dry cough.
 
In Britain, ENT doctors have urged health authorities to advise people with a sudden loss of smell or taste to self-isolate even if they have no other symptoms.
 
"Anything we can do to delay transmission is absolutely vital," Claire Hopkins, the president of the British Rhinological Society, told AFP.
 
Hopkins, who published an open letter on the issue on Friday with ENT UK chief Nirmal Kumar, said she was not surprised when she heard initial reports from Iran and France of COVID-19 patients reporting a loss of smell.
 
Around 40 percent of cases of sudden loss of smell in adults are caused by post-viral anosmia, she said, and previously known coronaviruses are thought to account for up to 15 percent.
 
But she said the turning point came when an Italian colleague working in a hospital in the worst-hit north of the country mentioned he had observed a high incidence of loss of smell among frontline health workers.
 
This led to a flurry of posts on professional message boards.
 
"We all started to note an increase in patients who were young and otherwise completely asymptomatic presenting with new onset sense of smell loss," said Hopkins.
 
Nine out of the 20 patients she saw last week had recently lost their ability to smell.
 
"That's extremely unusual," she said, adding that several of these patients had called Britain's health authorities concerned about COVID-19 but were told there was no need to self-isolate because it was not a recognised symptom.
 
'Significant symptoms'
 
Experts in several countries have flagged anosmia as a potential sign of COVID-19.
 
In France the head of the health service, Jerome Salomon, on Friday said ENT specialists had observed a "surge" in anosmia cases and said while it was still relatively rare, it had been seen in younger patients with "mild" symptoms.
 
The American Academy of Otolaryngology-Head and Neck Surgery on Sunday noted growing anecdotal evidence that anosmia and dysgeusia—taste disorder—were "significant symptoms" of the virus.
 
In Germany, virologist Hendrik Streeck from the University of Bonn, went house to house in Heinsberg, where around 1000 people were put under a two-week quarantine in February because of a local outbreak.
 
He said some two thirds of infected people reported losing their sense of smell and taste for a few days.
 
"It went so far that one mother could no longer smell her child's full nappy. Others couldn't smell their shampoo anymore and their food started to taste bland," he told the Frankfurter Allgemeine Zeitung newspaper.
 
Help for health workers
 
A lack of testing in many countries means that often only those with the most severe symptoms are confirmed to have the virus.
 
But several high-profile patients with milder cases have reported a loss of olfactory senses.
 
Nadine Dorries, the first British politician to test positive, said she lost both her sense of smell and taste.
 
"Eating and drinking warm or cold that's all I can tell," she posted on Twitter last week.
 
French basketball player Rudy Gobert, 27, whose positive coronavirus test prompted the NBA to shut down its season, tweeted he had not "been able to smell anything for the last 4 days" on Sunday.
  Abscent, a UK charity that provides support and advice on olfactory training to a relatively small community of people who have lost their sense of smell, has seen interest "skyrocket", according to founder Chrissi Kelly.
 
Hopkins has been "inundated" with emails since her statement was published.
 
Many people reported that close contacts and family members had also experienced anosmia symptoms within recent weeks. This is unusual, she said: "We certainly don't get clusters within groups of friends and family reported in the same way."
 
She said the advice on sense of smell loss could be particularly useful as a sign for medical workers to get a test or self-isolate, even without other symptoms.
 
"A healthcare worker who is infected unknowingly and spreading infection around colleagues is a disaster because we need to keep the workforce as healthy as possible," she said.


in : medicalxpress. com/news/2020-03-loss-reveal-hidden-virus-cases.htm
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
(03-25-2020, 11:22 AM)odellconnie Wrote: On 4. I would boil the tap water (I have a plug in electric kettle for when I can’t buy distilled water locally, such as now).  There are often/always? chlorine-resistant organisms in your drinking water/taps which are fine for your gut, but not so much for your nasal passages, I think they have a more direct path to your brain.  Just like for a neti pot.  There are not that many cases each year, and fatality varies by location, but I think it’s best avoided...

Are you aware that you breath more tap water aerosol when you take a shower then you ever will from a CPAP?  The risk associated with Neti pots is the forceful injection of a couple of hundred mL of tap water into the nasal passages. To compare that with the almost negligible aerosol generated by a CPAP is not valid. CDC cautions against the use of tap water in neti pots but doesn't caution against its use in CPAP or taking showers.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
I appreciate the spirit of this thread, but I also wonder, if using cpaps is a real possibility in cases of pneumonia related to cov 19, aren't there researchers or drs out there who could provide more concrete guidance? That's what would help me most. If something can be done for me or my family using a cpapd device, I really need step by step directions. Lung flutes and changing settings without that seems quite daunting. Thank you.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
So it seems like the consensus is becoming that some form of assisted ventilation, whether CPAP or Bilevel, is better than nothing, and may allow you to avoid hospitalization if started early enough at home.

The question in my mind, then, is: what is the minimum EPAP setting needed to affect alveolar collapse? Is it known? Does it vary by weight?

Also, is it better for alveolar collapse to use CPAP at a high pressure, say, 18, or bilevel at 18 IPAP and EPAP of 9? Bilevel is certainly going to be more comfortable. Where in your exhale cycle do you get the benefit?
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Is there a danger of aerosolization of SARS-CoV-2 from PAP therapy?
Is there a danger of aerosolization of SARS-CoV-2 from PAP therapy? I saw a post elsewhere saying that is an issue and non-invasive ventilation of COVID-19 patients requires a negative pressure room, but I haven't been able to confirm the claim. If that is the case it could have consequences for families, caregivers and others in a home or care facility where people with COVID-19 are using PAP machines.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Absolutely, there's a danger to families and caregivers. The masks vent a huge amount of air, and if you cough wearing a mask, it's going to super-vent those particles into the room. Lots of the discussion has been about finding a filter material to place over the mask vents, but... we know from previous experience that modifying the mask vents risks leaving too much exhaled co2 inside the mask for you to breathe.

My inner pessimist says that by the time you're symptomatic enough to need to do this, you will have been contagious inside your own home for at least 5 days, so... that cat's out of the bag anyway. But I certainly understand why hospitals wouldn't want fan-assisted contagion clouds hanging around from widespread *PAP use.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
I am really grateful that people have jumped on this Worst Case Scenario thread. But it has made me realize that I don't know nearly enough about either my own treatment or the AirSense10 I use. Is there a place where I can get a decent tutorial about the various pressures and mechanisms you're talking about. They go right past me and I think I need to understand them. Anyone?
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Folks, keep in mind that no health care professional will tell you right now to "treat yourself for COVID-19 at home using CPAP" or offer you ways to "adjust your CPAP to act more like a ventilator".  There's just too much legal liability for them to do that.  They've been trained and instructed to never endorse the concept of self-treatment for COVID-19 with anything except that which has been tested, proven and authorized by your personal physician.  Plus, none of them have the time right now to come here and spend a lot of time discussing these things or reading through this huge thread.

When the hospitals get full and they start turning away older patients, you are most likely on your own.

That's what this thread is about - patients helping one another for a future time in which the health care system cannot help us.

Let's keep this thread on-topic as well.  We can post medical information, papers, articles, etc. of course.   And our own thoughts and ideas too... But (as some have been telling me via emails & PMs) to "stop discussing these issues and ideas" and to "rely solely upon a medical professionals"  is all well-and-good during normal times, but should not apply at a time when our medical systems become overwhelmed and unable to serve the entire population.  That type of advice goes against the primary purpose of this thread.

Thanks
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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