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[COVID-19] CPAP use for Coronavirus mitigation & severe pneumonia
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Here is a quote from an article in The Atlantic that was posted on their website 27 March 2020. It was written by an Emergency Room medical doctor in New York City.
"Earlier in the month, we were told that positive-pressure oxygen masks, such as CPAP machines, were risky, as they would aerosolize the virus, increasing health-care workers’ risk of getting infected. But in recent days, running dangerously low on ventilators, we have attempted using CPAP machines to stave off the need for medically induced comas."

Because this is my first post to this site I am not allowed to provide the link to the article. If you are interested in reading the article perhaps you can google its title, A New York Doctor's Warning.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Nothing new in The Atlantic article except the anecdotal observations of a "resident" being published in a media outlet with a penchant for politicizing the current emergency and attacking the current administration. 

The risks are well known and controllable. Not so much in a home setting where additional concern may be warranted. Since I use a nasal mask, I am not prevented from coughing or sneezing independently of the exhalation airflow from my mask.

As for following New York's lead, I think not. Their governor was warned of a pandemic after SARS and H1N1 and did little or nothing to address the issue at the state level. Now he is excoriating the Administration demanding more -- more money, 30,000 ventilators, and other federal assistance. Here in California, we are finding that the State did not fund the maintenance of an existing emergency stockpile and multiple thousand-bed portable hospitals -- which would have made a major difference, especially for containing the spread of the virus among the mobile homeless population who are already in ill-health, addicted, live in close proximity, and in unsanitary conditions.

We are learning -- or should I say re-learning -- what we should have already known. 

Quote:Airborne Precautions.

Airborne Particles Generated from Medical Equipment Besides patients, there are also several medical and surgical procedures that can generate aerosolized particles. In most cases, these airborne particles are generated during manipulation of the large airways. Examples include: Manual ventilation with a bag and mask. Intubation. Open endotracheal suctioning. Bronchoscopy. Cardiopulmonary resuscitation. Sputum induction. Surgery on the lungs. Nebulizer therapy. Non-invasive positive pressure ventilation (BIPAP, CPAP). An autopsy on the lungs.

Free full-text article

Quote:Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review

Procedures that are believed to generate aerosols and droplets as a source of respiratory pathogens include positive pressure ventilation (BiPAP and CPAP), endotracheal intubation, airway suction, high frequency oscillatory ventilation, tracheostomy, chest physiotherapy, nebulizer treatment, sputum induction, and bronchoscopy. Although those procedures are known to stimulate coughing and to promote the generation of aerosols, their risk of transmission of infection is not known with certainty. It is worth emphasizing that the scientific evidence for the creation of aerosols associated with these procedures, the burden of potential viable microbes within the created aerosols, and the mechanism of transmission to the host have not been well studied. It is unclear whether these procedures pose a higher risk of transmission and whether HCWs caring for patients undergoing the aerosol generating procedures are at higher risk of contracting the diseases compared to HCWs caring for patients not undergoing these procedures.

Prolonged exposure and poor infection control compliance, such as poor hand-washing, may be associated with an increased risk of occupationally acquired infection . Inadequate spacing, and the ineffectiveness of personal protective equipment may also contribute to nosocomial transmission. There is some evidence that training programs and the use of personal protective equipment are associated with a decreased risk of transmission of SARS. For instance, with proper control measures in three key areas (including staff personal protection, categorization of patients to stratify risk of SARS transmission, and reorganization of the operating room), high risk aerosol generating procedures (surgical tracheostomy) performed on SARS patients appeared to be associated with a low risk to HCWs who were in direct contact with the patients in the operating room.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Hi Lars,

Welcome to the Board!  You are probably looking for info for a loved one since your info is generic.

Thanks for that info about The Atlantic.  There has been huge change in treatment posture in even a few days as the medical staff get overrun by a tsunami of patients.  What was seemed horridly unprofessional last week is now survival mode (Pampers as masks, garbage bags as disposable gowns, etc)

I think a mental shift will happen, within a few days or a week.  The wards of ventilator patients will be deemed to already be contaminated, so f-it on keeping the COVID-19 out of the area.  At that point PAPs that aerosolize into the room will be accepted.  It's not the disease that kills per se, its the ARDS and pneumonia.  The protocol will be on keeping the staff alive, which means contagion suits for them.

Ignore any political commentary here.  Normally it does not happen.

Make a shopping mask for you and your loved ones, wash hands, stay home, take care!
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Here is one guys invention.  A retired respiratory therapist from London Ontario. 

I took a quick look at it.  He has three speeds, high, medium and low.  Just like the bicycle I had in grade school.  I think it is too simple, at least compared to us using our XPAPs, but someone with greater technical knowledge may see potential there.


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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Cpapian, that device is for hospital use, where the patient is intubated. Like all such ventilators it requires full time qualified nursing care. The website is very clear - this device is for hospitals, not at-home care or DIY. So if you have a hospital short on equipment this might help. For those of us looking for a home-care alternative, this is not it.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Others here have touched on matters I have been mulling over and been seeking info for, info pertinent to the use of copper or ozone to disinfect xPAP mask exhaust. Other similar posts can be found by searching the word "copper" in a post; limit the search to, say, threads with 340 posts. Hits, for example, on posts by Crowtor, WMMack (?WMMMack), Stephen N (I think) and Dan451 will come up--members who've also touched on exhaust scrubbers I 've given some thought to. Bubbling mask exhaust through a liquid scrubber may have more merit than anything below. You may wish to just go to the links directly, if the ideas employing copper surfaces and ozone info are familiar and you want more info on copper and ozone use.

The negative pressure tube-tent approach in the ending paragraph appeals most to me: simple, easy, things available from hardware, builder, painter stores, if not on hand. I'd prefer an axial fan with a housing to move the air from either outside a window, baffled to prevent backflow into the room, or have it mounted inside tube opening just down airstream from the bed..

Some points.

1.  I started looking at copper after seeing mention of it in this thread but was deterred by one of the links below that indicated too much time of contact was required. Days later I looked farther an hour ago and found work by Keevil and Warnes (MDs, I think) indicating much shorter times. The "slow and fast articles" are linked below. 

Like one member, I had envisoned a scrubber that was packed with the copper scouring pads that are available in food markets, those being packed into a piece of PVC appropriately (air resistance, copper-bypassing issues satisfied, necessarily). Chem engineer/physicist/other such person, please weigh in if ideas here are a dead end; don't lie there ROTFLYAO Dielaughing .

Copper is too slow?:   


Copper might be fast enough with artful design, though expensive (long baffled path, relatively large cross section for low resistance, slow passage):

2. Ozone kill time and concentration was considered at the following link. 
Again, lots of time and concentration issues. If a UV bug-zapper tube-kind of idea is in the realm, then … but you have the ozone to be exhausted outside the inhabited space. 


3. So why not--as others have mentioned in one way or another above 

a) tent the patient, have the xPAP blower outside the tent, the xPAP hose go through the tent wall to the mask and a duct--I can't think of the name for ducting I have in mind, but it is similar to the flexible tubing used to exhaust hot moist clothes dryer air to the outside. True, that has patients eyes and lips in air contaminated by exhalation. 


b) fashion a large funnel that captures mask exhaust with near zero back pressure and enlarges to enclose and be sealed around the perimeter of a large enough area HEPA filter (assuming effectiveness, which I don't know and may have already been addressed in this thread).


c) just run a tube, lightweight and sealed at the mask, to a window?  

4. It seems 3c above would be easiest to do at home and make access to the patient easiest. A box fan could be rigged just outside the windows to draw air out of the living space (negative pressure) and, possibly to draw exhaust out of the tube/box-channel conveyance.


BUT a tube tent like I carried and sometimes used in Sierra Nevada mountain rains could be made large enough for the bed; have one open end funneled down to seal to a tube extending to a window. Have a fan at the window or at the small other end of the spout near patient). Fan draws clean room air inside the tent and pushes it out the window along with mask exhaust. (This just came to mind and I like it best: simple, cheap, easy. Just a large funnel with a bed in the big end (in effect) similar to those used to put transmission oil in cars. The order of parts from the smaller spout tip outside: an exhaust port opening that penetrates a window baffle, the long funnel spout, the fan (if not at window), the head of bed (or foot), the patient, a head-height-diameter funnel opening out into room.

Maybe one of these flaky ideas will help someone else's mind click on THE solution for home use.

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RE: CPAP use for Coronavirus mitigation & severe pneumonia
OK, I have read through this thread as best I can. Please forgive me if I have missed something.
It seems that with my machine the drill is as follows:

Ensure 8-12 cm pressure support. I am now at 17-8. BiPAP is essentially a ventilator.

Use it 24/7 if need be to aid breathing. 

May help other family members with breathing issues during this pandemic.

Is that the size of it? Do I need to up the pressures or not ?
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
This article is also speaking toward some other comments I have read on this topic.


Personally, when push comes to shove, I will be trying to use my machine as a ventilator. It looks like, however, that I now need to look into working on a way to filtrate the expelled air. I don't want to be aerosolizing Germs.

I wondering if anyone at the CPAP companies are looking into this potential problem. Even if you are asymptomatic you could be super spreading the problem throughout your living environment.

One of the responses I found in the social media site along with this article was:

I am a respiratory therapist. Our hospital has a back up plan to use bipap machines as ventilators, not with the mask but with an endotracheal tube. This is our last resort and we are close to using them and other hospitals near us are using them because we are out of traditional ventilators. The problem is they have limitations as to the scope of use, they do not allow for advanced technique and specialized settings that we are finding the covid patients require. But we will do whatever we can to save our patients.


PS: Hoping this is an acceptable link and doesn't violate hyper link posting rules...
My worst night on CPAP is 10X better than my best night without it  Eat-popcorn 
Good night Chesty, wherever you are..Semper Fi
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Very good article here that came out from NPR yesterday CPAP Machines Were Seen As Ventilator Alternatives, But Could Spread COVID-19

Quote:How CPAPs spread the coronavirus
Ventilators are machines that push air in and out of the lungs through tubes inserted down patients' airways when they have trouble breathing on their own. The machines allow health care providers to fine-tune the volume of air supplied, the rate of breathing, the amount of oxygen and the pressure as needed.

Both hospital and home versions of positive airway pressure machines are much simpler devices that use high pressure to push air into the airway, generally through a face mask. Continuous positive airway pressure machines, known as CPAPs, provide a continuous flow of air at a constant pressure. More advanced bilevel versions, called BiPAPs, which can be used at home or in health care facilities, push the air in, but then lower the pressure to allow the air to be exhaled.
"You can actually function certain BiPAP machines to run like ventilators," said Dr. James Finigan, a pulmonology and critical care specialist at National Jewish Health in Denver.

The key issue, Finigan said, is how the device connects to the patient. Ventilators require a breathing tube and operate as closed systems with a filter that traps any pathogens. Face masks generally used on CPAPs or BiPAPs allow air to escape, pumping the virus into the surroundings and potentially infecting other patients, caregivers or anyone nearby.

Positive airway pressure machines are often the first step in the standard algorithm for hospitals or emergency personnel when treating people with certain breathing problems. Finigan said in patients with standard respiratory failure, doctors might first see if patients can get by on high-flow nasal oxygen or on BiPAP machines to avoid intubation and sedation.
"If your hope is that maybe this might be a temporizing measure that might hold them from hours to a couple of days, you'll try to use the mask," Finigan said. "There are some situations where somebody is breathing OK, but is just having trouble getting enough oxygen. Theoretically, a CPAP might be enough to get them enough oxygen. But, again, doing it with a mask is more likely to generate an aerosol and create an infectious problem."

Dr. Jeff Sippel, a critical care specialist at UCHealth, based in Aurora, Colo., said BiPAPs could be used for COVID-19 in a closed system without a mask, if patients are first fitted with a breathing tube.
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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Great info SR, thanks.

There again, I am looking at all this as a possible alternative where there is no other alternative. No place to go, SpO2 falling, etc.

The above NPR article speaks about stopping using CPAP if symptoms appear or you test positive.

So, where to go from here?

In the NPR article the prospect of a "Sick Room" was brought up. Luckily I have a second floor guest room with full bath, so that is available.

I guess that if you feel ill at all you would stop CPAP, if you can, for a couple days and get tested. If you are positive stop CPAP and monitor your vitals. If necessary start CPAP therapy in a sick room...?

You know, even if this were only looked at from from a cold or flu spreading issue, you would think that someone would have came up with a CPAP sick filtration mask or mask disease filtrating attachment.

Thanks again, I'm back to the drawing board...

My worst night on CPAP is 10X better than my best night without it  Eat-popcorn 
Good night Chesty, wherever you are..Semper Fi
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