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[COVID-19] CPAP use for Coronavirus mitigation & severe pneumonia
#61
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Great info SS and Kudos for broaching this subject. Since I PMed you a few days ago I have been looking further into the use of CPAP as a resource far a "no professional medical access alternative". I was also considering other "out of the box" ideas in case my hopes that my machine would be of little or no use where a medical ventilator is absolutely critical to my survival.

One thought was a air compressor as air volume can be regulated. I'm sure I could easily adapt a CPAP hose to work well with it. I believe I read one of your threads awhile ago where you equated PSI to cmH2O or I could use a compression gauge on my CPAP and get that number.

A big problem with most any alternative is you will also need to have someone else shown how use whatever system you develop. If you contract severe pneumonia you will slip into a coma like state and start drifting in and out of hallucinations. Someone needs to be watching you and making sure you don't rip off the mask, etc.

The Vacuum motor would need two regulated and synced outlets. If say you ran it into a 3/4 inch PVC to a ballcock step down to a 1/2 inch to a hose connector is the simplest way, but you would be placing excessive back pressure on the motor as I would think that pressure to your lungs would need to be stepped down. so, if you ran created a "T" off prior to the ballcock and therein placed a ballcock you could allow for pressure relief for the motor. You could give yourself as much pressure as you wanted while also releasing enough back pressure so as not to burn out the motor. A vacuum motor, depending on the make and model, be able to support maybe up to 2 persons? A PSI valve could be installed to regulate and gauge pressure.

You might also run the power through a AC Power Regulator/Transformer and increase/decrease motor speed to output a regulated amount of air pressure.

You will also want a vacuum cleaner that you can easily disconnect the hose from the suction intake and attach to a discharge port. Kirby has always had that capability. They have a special attachment when the hose is connected to the air discharge you can put on the attachment and plug a drain opening and blow out the clog. It also works great on toilet plugs. Black and Decker motors will blow out any drains easily. I have a couple older Kirby's and any used Vacuum shop will have them.

If anyone is interested I could draw up a diagram with needed components. Likely less than 30 dollars.

With an air compressor you will need to inhale and then release the trigger, exhale and then again depress the trigger. This is fine as long as you are conscious and aware of your surroundings. Unfortunately that is not always the case.

Sp02 is extremely vital to recovering from severe pneumonia. Once the Sp02 drops other organs begin failing, the heart begins pumping like crazy trying to create Sp02, etc., bad deal all the way around.

Personally, I believe my machine would work well if the level of virus contracted is not severe. In my reading no person should be administered above 40 cmH2O and mine is made for up to 30 cmH2O. With low to medium level viral pneumonia I feel I have a shot at survival.

The main purpose for a ventilator is fill the patents lungs to capacity.

There may be a need for people to make or create alternatives to CPAP machines or Ventilators as those may not be readily available so ideas like vacuum cleaner motors or air compressors may need to be looked at. Hey, if ya got nothing...make something.

I'll be doing more research and have calls into my pulmonary Doctors office about this. I doubt he will be calling me back soon as he is likely busy.

One last point on a positive note is that this is a viral disease and thus will produce viral pneumonia and that is far better than what I had, which, was severe bacterial pneumonia. Bacterial pneumonia creates mucus that cannot be expectorated and forms a glue like coating that covers the lungs. It is also very fast spreading. You get symptoms and a couple days later (3-4) you are in the ICU.

Thinking-about
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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#62
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Thanks Cpapian!

Just in case those links go bad, I'll repost the content here in this thread.

First, from the Vice article (here):



Quote:People Are Trying to Make DIY Ventilators to Meet Coronavirus Demand

As countries face shortages of important medical equipment during the COVID-19 pandemic, makers are desperately trying to fill the gaps with open source designs.

by Maddie Bender
Mar 17 2020, 7:00am

[Image: 1584452597107-Untitled-design-5.jpeg?cro...size=700:*]

As countries affected by the coronavirus pandemic expect to run out of ventilators and other equipment, makers are desperately trying to fill the gap with proposals for open-source, do-it-yourself devices.

Most cases of COVID-19—the disease caused by the novel coronavirus—do not require hospitalization. But for people hospitalized with severe infections, coronavirus damages their lungs and makes it hard to breathe in and circulate the amount of oxygen that their bodies need. Ventilators, machines that provide the lungs with oxygen, are proving to be key to treating these people, who seem to comprise around 10 percent of cases.

Governments are already preparing for what a shortage of ventilators could do to their health care systems.
In a call to U.S. governors on Monday that was shared with The New York Times, President Donald Trump told states not to rely fully on the federal government for equipment. “Respirators, ventilators, all of the equipment—try getting it yourselves,” he said, according to The Times. “We will be backing you, but try getting it yourselves. Point of sales, much better, much more direct if you can get it yourself.”

Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said on CNN that the U.S. has stockpiled 12,700 ventilators, but in a worst-case scenario that number might not be enough. In Italy, he added, physicians are having to make “very tough decisions” about whom to treat.

On the other side of the pond, UK Prime Minister Boris Johnson has urged engineering firms
to switch production to manufacturing ventilators, a call echoed by Secretary of State for Health and Social Care Matt Hancock. “If you produce a ventilator, then we will buy it. No number is too high,” he said on Sky News.

Some believe that makers can do their part to solve the shortage. Julian Botta, a third-year emergency medicine resident at Johns Hopkins University who said his views do not reflect those of the university, put together a Google Doc called “Specifications for simple open source mechanical ventilator.” In it, he lays out the key features of the kinds of ventilators used for coronavirus patients. He also proposes a design for an open-source ventilator after seeing that engineers were interested in designing ventilators but didn’t know much about how they worked.

Several other groups have popped up on various points of the design spectrum, from sharing information to drafting and 3D-printing ventilator parts. Newspeak House, a “hackspace for politics” in the UK, started the Coronavirus Tech Handbook to crowdsource information about COVID-19, including links to open-source equipment designs and other resources. Nathan Young, a resident fellow at Newspeak House who helped create the handbook, wrote in a Medium post that if the hub “causes two people to meet and develop a tool that saves a lot of lives, it just might be the most impactful thing I ever do.”

Despite his proposal, Botta said that the specific features of ventilators do not make them inclined for simple DIY replication.
Before he wrote up his idea for a ventilator, he saw designs posted in Facebook groups (similar ones have popped up on GitHub) that amounted to jerry-rigged continuous positive airway pressure (CPAP) machines—these sorts of devices can’t sense how much oxygen is getting into a patient’s lungs and aren't nuanced enough to support people with coronavirus-caused respiratory distress, he said. His idea, in contrast, contains feedback measures and sensors that would trigger alarms in case of malfunction or inadequate oxygen flow.

Another challenge for DIY or open-source ventilator proposals is approval by hospitals and regulatory agencies. As the burden of the pandemic worsens, regions may see deviations from their standards of care, Botta said, giving the example of triage in Italy. Even so, there is not a straightforward path to implementing DIY ventilators in hospitals.

“It would be very, very challenging to get [open-source ventilators] approved, especially if it's being manufactured essentially by home hobbyists, because there's inherently not much consistency in how things are going to be made,” he said.

Gui Cavalcanti, the founder of “Open Source COVID 19 Medical Supplies," a Facebook group formerly known as the “Open Source Ventilator Project," was made aware of these challenges and decided to pivot away from ventilator design.

An engineer by training, Cavalcanti called first responders in San Francisco who told him to focus instead on other equipment necessary to the public health response, like masks and gloves. “They said, ‘Listen, ventilators are not the issue. The issue is literally everything else,’” he said.

Cavalcanti created the Facebook group last week to act as a repository of information and open-source designs for medical supplies, and it has already grown to over 5,000 members. Cavalcanti said that he and the other leaders of the group are working with distilleries and fabricators to produce hand sanitizer.

One member, Trevor Smale, published preliminary open-source designs of a low-tech ventilator that can be pumped by hand to provide oxygen to a patient. Smale and a handful of close friends, he said in an email, combined designs by groups at MIT and Rice University to create a DIY version of a device known by its brand name as an Ambu bag.

"The chaotic fervor and ideation going on all over the place on various forums and social media platforms meant ideas were atomized and difficult to capture," he said. "After getting some very helpful information and positive reinforcement from experienced front line professionals on the Open Source COVID19 Medical Supplies group and researching elsewhere, I knew that a small, simple and automated ventilator would be a valuable commodity, so I started the GitLab project."

Meanwhile, groups in Italy and Hong Kong have 3D-printed face masks to use personally and donate to hospitals. Isinnova, an Italian startup, 3D-printed 100 valves that connected ventilators to coronavirus patients’ oxygen masks after hearing about a shortage from a local hospital.

Cavalcanti said that he does not see Trump’s statement to governors as a call to action for makers. Though he expects that the group will eventually coordinate with local and state governments, “our main megaphone is going to be getting local makers to make things according to vetted plans,” he said.

He added that the maker and open-source movement can be especially useful for people who cannot access high-quality health care in hospitals by nature of where they live or how overloaded the system becomes.

“This is a pandemic that's going to happen everywhere. It's not going to discriminate, and if we aren't making sure everybody's taken care of, we’ll continue to get sick.”


Note:  Posted article content under "Fair Use" US Copyright Laws.
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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#63
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Next, reposting the text of the Github project from (HERE):

(apparently he began working on this project less than 2-3 days ago-- if anyone has a Github account, you may wish to reach out to him to let him know about this thread and perhaps we can get more people collaborating on this)



Quote:Low-Cost Open-Source Ventilator-ish Device

In the event that COVID-19 hospitalizations exhaust the availability of FDA approved ventilators. This project documents the process of converting a low-cost CPAP (Continuous Positive Airway Pressure) blower into a rudimentary ventilator that could help with breathing during an acute respiratory attack.

WARNING/DISCLAIMER: Whenever possible, please seek professional medical care with proper equipment setup by trained individuals. Do not use random information you found on the internet. I am not a medical professional, just a random person on the internet.

This rudimentary design could provide a target breathing rate, and a positive end-expiratory pressure (PEEP). It can't guarantee a specific tidal volume, and doesn't regulate specific fractional oxygen (FiO2). With an attached O2 tank, it could provide 100%. Without a tank, it just pushes atmospheric air of 21% O2. Any other ratio would require manual guess work on the O2 supply flow. It is lacking in many ways, but it is possible this limited functionality could help when better care is not possible.

Here's a youtube video walking through the components as of 2020/03/17:






To Do's (aka. things that I could use help with):
  1. A pulmonologist that (while understanding this is not an FDA approved device) is willing to advise on how to make this more effective as a last resort.
  2. A supply chain person that can help us find good suppliers of parts. If there is desire to make these, I don't have a supply chain setup. The few parts I have on hand may not be easily sourcable in any volume quickly.
  3. Figure out how to reprogram an existing CPAP. If this operating mode is helpful, there's a large number of these device's already in the field which could be enabled. I don't have good stats on the popularity of different makes/models. There could be on the order of a 1M devices worldwide?
  4. Design modifications to recapture exhaust to minimze addition viral spread. This only works in already "dirty" environments, where there is likely already airborne droplets containing virus - such as quarnateened spaces or other negative air pressure environments.
  5. Test with a simple inflator pump and achieve the same pressure control.
  6. Develop Arduino compatible algorithms to align blower cycle the breathing cycle by looking at backpressure load on the blower.
  7. Develop a better solution to the mouth guard. Current solution would require a bunch of tape to create a sufficent forward pressure.
  8. Solutions to prevent the system from becoming unsafe if power is lost. It's not obvious to me on how to do this. Ideas welcome.
  9. A 3D model for an inline air filter with link to common filter supply such as this

References about the supply and potential shortage of ventilators:

Here we will briefly summarize information on the supply and potential shortage. Key numbers that will affect this:
  1. The current numbers for supply of ventilators (# of ventilators currently)
  2. The demand for ventilators, over time (# of ventilators needed over time)
  3. The ability to increase supply of ventilators (# of ventilators able to be manufactured over time)
Additionally, the numbers above will vary based on each region's need globally.
Some preliminary data (we can continue to update) on some of these areas:

Region
# ventilators, current supply
# ventilators, neededGlobe


U.S.
46,000 [1]
200,000 or more [1]
California
7,587 and "buying more" now [2]

U.K.
5,000 [3]
> 30,000 [3]


References
  • [1] Text from my friend who is a doctor at Stanford, let's replace with citable sources if possible. "Estimated 46,000 vent beds across US with anticipated need of 200,000, maybe more if more severe than we know"
  • [2] Gavin Newsom press conference, March 15, 2020 (add link)
  • [3] https://www.ft.com/content/7ebb238c-67c7...e6fedcca75
References from doctors specifically about ventilator technical requirements
[/url]
Specifically for COVID-19
Tweets from Vamsi Aribindi, MD (March 13, 2020)
https://mobile.twitter.com/aribindi/status/1238629714069032961

Specifically for ARDS (which is associated with COVID-19)
Journal article about treating ARDS (2017): https://www.nejm.org/doi/full/10.1056/NEJMra1608077

References about CPAP/BiPAP/PEEP ventilator modes
Lung Mechanics: PEEP,PEP,ACMV
Ventilator Modes Explained! PEEP, CPAP, Pressure vs. Volume

Materials
  1. Continuous Positive Airway Pressure (CPAP) devices are commonly used by individuals to treat sleep apnea. As a result, CPAP blower components are fairly abundant. Used ones are available on eBay and new ones on Alibaba. In many of these devices, the blower is a simple BLDC motor that can be driven with an Electronics Speed Controller (ESC) used by quadrotors and RC cars. The one I used is pulled from a Respironics REMStar. In volume, these blower components can be under $20.
  1. Arduino Compatible Nano/Clone to control the motor speed, breathing cycles, and handle user input. Download the Arduino IDE to program the microcontroller software.
  2. Brushless DC Motor Electronic Speed Controller capable of at least 10A.
  3. Button or swtich for input control. The code cycles through 5 levels of pressure, and double click to swtich between CPAP and BiPAP/Fixed PEEP mode.
  4. 12v DC power supply that can handle at least 5A. The blower works pretty had, and the breathing cycles can create voltage drops which will reset the Arduino if the supply if not strong enough.
  5. Tubing and face mask. If you search for CPAP face mask, you'll find many options/suppliers. The full face mask that covers both the mouth and nose and enabled pressure buildup in the lungs. As an alternative, see below for draft 3D printable parts.
  6. Optional inline 12v battery backup.

Building

This is the full system, with mask, tubing, pump, 12v battery, and swtich for input. However, I would strongly recommend running with a DC power supply since the battery will only last about 3-4 hours. Wearing the mask with a dead battery could cause dangerous CO2 build up. This [url=https://www.amazon.com/gp/product/B07H8F5HYJ/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1]particular battery can charge and supply power at the same time, acting as an inline battery backup to wall power.

[Image: full%20system.jpg]

Below is a close up of the extracted blower. It simply an BLDC motor driving a blower fan. A small ESC and Arduino attached (technically a Teensy2.0++, but the code has now been changed to an Arduino Nano). It has a 3d printed tapered hose adpater on it to fit in the hose. The microcontroller software can be programmed with the Arduino IDE. The software goes through a short initialization sequence to configure the ESC, and then starts at the lowest CPAP setting. You can use the switch to cycle through pressure levels, and double click to cycle through operating modes.

[Image: IMG_20200315_230153.jpg]

Here is the schematic for the electronics. As you can see, it's very simple with only a few parts. A slightly modifed version that is able to sense the blower current is here.

[Image: schematic_20200317.1.jpg]


Face mask / Tube Adapter

Since I have CPAP, I happen to have a Resmed AitFit F20 mask that I can use. This is quite comfortable and covers both the nose and mouth to make a good seal. However if you can't get a mask, below is a prototype mouthguard that fit in the category of not-so-great-but-usable-if-you-have-a-lot-of-tape. I am using some elastic straps as head gear. But to get an good air seal to get enough positive pressure would require some tape. A little bit of leakage is actually desirable to allow CO2 to escape near the mouth nose and flushes out the air over time, rather than being stuck in the tube. WARNING: wearing this sealed to the mouth with tape without power may cause dangerous CO2 build up.
Download the [3D model] [Fusion 360 link].

[Image: mouthguard.jpg]         [Image: mouth_guard_model.JPG]



Pressure Testing

This is a picture of my test rig to measure the output pressure. It's a U-shaped tube with attached measuring tape to check displacement of water. The actual liquid displacement is 2x the measured line since liquid is being push downwards on the other side of the U an equal amount, doubling the displacement. (I think this is the correct way to measure). At full blast at 12v, it is achieving 45cm/H20. Guidance on ventilators for COVID-19 patients require upto 20cm/H20. So, these blowers are plently powerful.

[Image: test_fixture.jpg]


[Image: 3cm.jpg]     [Image: 6cm.jpg]


[Image: 11cm.jpg]      [Image: 22.5.jpg]


Here's a video of the blower pushing a breathing cycle of 16 cycles/min oscilating between 12 and 22cm/H20.

Air Filtration - Optional

An open air blower into someone's airway isn't great. If possible, some filtration is preferred. These parts were originally used for a DIY Powered Air Purifying Respriator (PAPR). However, adding a filter will definitely affect the output pressure. It will depend on the blower you have if the motor can handle the additional load. Given the headroom of the blower I tested, these CPAP blowers can probably handle the filter and still hit the target pressure. However, I haven't done longterm thermal testing at high pressure and a strong filter. These adapter plates can be attached with liberal amounts of hot glue, and wrapping the unit in vinyl tape to get a reasonably airtight seal. My blower's enclosure was not air-tight, so it is difficult to guarantee that 100% of the air is coming only through the filter.
[Image: 3m_apart.jpg]    [Image: 3m_attached.jpg]


This is an adapter plate for a NATO 40mm gas mask filter cartridge. These fitlers are available with CBRN ratings which are needed for viral and bacterial defense similar to those approved by the CDC/NIOSH. Download [3D model] [Fusion 360 link]


Note:  Posted under "Fair Use" U.S. Copyright Laws.
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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#64
RE: CPAP use for Coronavirus mitigation & severe pneumonia
@3rdMarDiv & others wondering,

1 cmH20 = ~0.01422 psi

An online conversion calculator from Cornell University:
http://www-users.med.cornell.edu/~spon/p...essure.htm
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#65
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Can someone log into your YouTube account, then go over to the comment section on Johnny Lee's YouTube video, here:

https://www.youtube.com/watch?v=n57u1NvXBgw

If you're able, post a comment and tell him that we're having this very discussion here on Apnea Board, and invite him over here-- perhaps we can collaborate on some of this.

I tried posting with a link to this thread, but the YouTube filters didn't allow my post to go through with the link.  Might want to post a message without posting a link in the comment (so it won't get caught up with YouTubes spam filters).

You might simply have to tell him to go to the Main Forum and look for the thread titled "CPAP use for Coronavirus mitigation & severe pneumonia".

Post here if you were successful in posting a comment there, please.  Thanks.

It would be super if we could collaborate and help this guy with this project.

Coffee
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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#66
RE: CPAP use for Coronavirus mitigation & severe pneumonia
SuperSleeper, just posted a comment on his YT video. Hopefully he will acknowledge and pay us a visit.
Using a 13" MacBook Air (2017), MacOS Catalina (10.15.7), OSCAR v1.2.0
In a VM: Win10 1909 (18363.1256)

Installing OSCAR on a Mac
Organizing your OSCAR charts
Attaching images and files for the forum
OSCAR Help
OSCAR Data Interpretation
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#67
RE: CPAP use for Coronavirus mitigation & severe pneumonia
(03-18-2020, 03:05 PM)Jeff8356 Wrote: SuperSleeper, just posted a comment on his YT video.  Hopefully he will acknowledge and pay us a visit.


Excellent Jeff!   ... FOLKS, if you have a YouTube account, please log into YouTube, then head over to this video (HERE) and find the comment by Jeff Norman and click on the "thumbs-up" icon so his post will eventually scroll up to the top of the comment section so it will be noticed.

Thanks

EDIT:  Also, please leave a short comment yourself, as this will help to push Jeff's comment up to the top (if there are more replies to him).

Perhaps say something like you're a member here, or you've been following this thread or similar comment.  The more replies there are under Jeff's comment, the more it will get noticed.

I finally was able to reply also with my own comment under Jeff's, so if you like, click on "thumbs-up" for that one also.

Thanks.
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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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#68
RE: CPAP use for Coronavirus mitigation & severe pneumonia
I read the threads here and I think people may be missing something. CPAP or a Medical Ventilator is not going to be just for breathing. If you are not unconscious you can breath on your own. An example would be if you suck in as much as you can to fill your lungs.

Your lungs are diminished greatly so they want as much SpO2 getting into your system as possible. Oxygen helps your body fight the disease.  They made a huge deal with the SpO2. I had a monitor on my forehead and a machine readout and they said if it keeps falling below 84 I was loosing the battle. They used one of those plastic inhale things that the plastic meter rises when you inhale occasionally to check my capacity.

I pretty soon went to 87 and they said to keep it up and I got to 90 and that was really good.

I don't think they cared about hyperventilating me. Your lungs are greatly diminished capacity so hyperventilation is probably less likely to happen.

They just wanted my SpO2 to go up as fast as possible.

The first 3 days I was mostly on another planet but, I was able to breath heavily for them.

You will need to breath more than normal as your lungs will be creating less SpO2 than normal. Everybody is different of course and hopefully your case is mild all the way around. I'm only addressing more severe pneumonia.

So, basically you need a Pulse-Oximeter to check often and I would crank my machine all they way up to 30 cmH2O. You want to cough as much as possible and spit out as much flem as possible. I had bacterial pneumonia so nothing came out. I just remember being told if I had viral pneumonia I could help myself a lot by coughing up flem.

This is if I get pneumonia of course or if my SpO2 starts dropping.

The reason I say that this is not a guess is because when I first got my CPAP machine I was diagnosed at 30/26 which I remember was a lot like the hospital ventilator.

I will crank it down based on my SpO2 readings and work real hard at keeping it over 93.

Feel free to correct any of my comments as I am only speaking from my personal experience and layperson knowledge.

Thinking-about
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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#69
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Thanks 3rdMarDiv,  that's kind of what I was thinking as well.

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
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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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#70
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Got an invite on YouTube for Johnny Lee
Dave

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