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CPAP use for Coronavirus mitigation & severe pneumonia
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Whilst I don’t live in the USA I was watching CNN this afternoon ( think that Governor Cuomo is really outstanding with his honesty and transparency - some could learn!). The CNN Chief Medical (Gupta ?) advisor spoke about the lack of ventilators in NYS and mentioned that CPAP machines are being considered as a bridge between nothing and medical grade ventilation. Maybe this will be a game changer for this thread as equipment manufacturers put their minds and resources to it.






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RE: CPAP use for Coronavirus mitigation & severe pneumonia
(03-26-2020, 10:07 AM)Clumpco Wrote: Have you guys seen this?
https://ideas.4brad.com/creating-plan-re...entilators

Sorry if this is a repost, the search didn't turn up any references to the link.

I have seen other similar proposals.  Others, like us are trying to figure out how to help ourselves when the medical system is overwhelmed and can't help us and/or supply the medical system with additional units.

In terms of treatment, the author seems to have made roughly the same headway our thread has accomplished.  However, I am not sure if all his assumptions are accurate.  i.e. A doctor refuted the idea of throwing maximum pressure at an ARDS case.  If I remember correctly from the Medcram videos on ventilation, the doctor and Medcram are in agreement. 

Also, the author wants to hook up computers to allow realtime monitoring.  IMO that adds an additional layer of complexity.  

So far I don't think the problem of how to handle the "open circuit" nature of XPAP has been solved.
Sleep-well
RE: CPAP use for Coronavirus mitigation & severe pneumonia
The point has been raised in previous posts that in a household, the concern for aerosolized virus venting from the exhalation ports of a CPAP mask and infecting other household members could be an irrelevant concern in the first place, because by that time, the other members of the household will have been likely infected already anyway.

That said, folks may wish to go back and read some of the solutions mentioned to mitigate this possible issue.  Several possible solutions have been previously stated.

None of these solutions are ideal, of course.  But again, we're talking about a time in which standard medical care will be unavailable.
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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
Also preventing exposure of the infected patient to more virus is unnecessary. The virus has already taken over his cells to produce more virus particles in large numbers. Viruses are not living organisms. They are essentially packages of genetic material that take over host cells to mass produce more virus particles.
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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
Hi together 
I fond today this article, maybe it is helpful.

http://www.uni-marburg.de/de/fb13/halble...p-solution


Stay safe Jim
RE: CPAP use for Coronavirus mitigation & severe pneumonia
(03-26-2020, 11:41 AM)Johnboy Wrote: Whilst I don’t live in the USA I was watching CNN this afternoon ( think that Governor Cuomo is really outstanding with his honesty and transparency - some could learn!). The CNN Chief Medical (Gupta ?) advisor spoke about the lack of ventilators in NYS and mentioned that CPAP machines are being considered as a bridge between nothing and medical grade ventilation. Maybe this will be a game changer for this thread as equipment manufacturers put their minds and resources to it.

Thanks!  Hopefully there will be a push for a firmware update from the manufacturers to at least provide better BiLevel function from standard CPAP/APAP machines.

Even if it raises the EPR from a Max of 3 to 10 or 12, it would be a help.

John
RE: CPAP use for Coronavirus mitigation & severe pneumonia
Sorry, sorry, I said that badly.  I can't edit my post now, but just ignore the last para of my last post.
Sleep-well






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RE: CPAP use for Coronavirus mitigation & severe pneumonia
Call me negative or skeptical, but I don't think the manufacturers are going to be on the lookout for assisting the common CPAP apnea user by creating or even allowing OTA updates to our machines. We are not considered the customer. They may devote time to make more NIV like machines for hospitals to buy, but again we're not the targeted "customer".
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
RE: CPAP use for Coronavirus mitigation & severe pneumonia
A team from research and technology from the Philipps University of Marburg and the University Hospital Gießen and Marburg (UKGM), in the face of fears that the ventilation capacity in the corona pandemic might not be sufficient, developed two different concepts for simple ventilation devices in a very short time. The devices can be manufactured quickly and comparatively inexpensively and can be used in situations in which clinics no longer have sufficient regular ventilation spaces.

The first concept is based on the use of so-called CPAP (Continuous Positive Airway Pressure) devices. These devices are used, for example, to treat sleep apnea and are available in many private households. According to an idea from the sleep medicine center in Marburg, the CPAP devices are being expanded so that they can be used for artificial ventilation. The first prototypes are already running and have been rated very positively by the relevant medical professionals at the University Hospital in Marburg. Production options for the devices are currently being sought.

The Chancellor of the Philipps University, Dr. Friedhelm Nonne says: “I am deeply impressed and grateful that within a few days this team, with exceptional dedication and in an unprecedented collaboration, has developed devices from many areas of the university and the university hospital that can help to improve the current coronavirus pandemic to manage something. The example shows how the expertise bundled in universities can be used to quickly contribute to overcoming societal problems. ”

The modified CPAP devices are not as powerful as professional ventilators. They are not suitable for the primary care of acute, severe COVID 19 cases with severe shortness of breath. In such cases, clinical ventilators must be used. However, if the patients have recovered after a few days to such an extent that they need less ventilation, the modified CPAP devices could be used for ventilation. Then clinical ventilators would be free again and available for the next person with acute problems.

For countries in which CPAP devices are not widespread, the team is currently developing simple devices based on so-called “ambu bags” as a second approach. These "Ambu Bags" or respiratory bags are used in first aid for primary care and are available in large numbers at low cost. They consist of a mask that is pressed onto the face and a compressible pouch that is pressed together by hand at regular intervals for ventilation. The team is now developing mechanical devices that periodically compress the bags.

The goal of the team is to make all technical information and building instructions publicly available. This is intended to create the opportunity to replicate the devices worldwide and to manufacture them in large numbers.

The medical director of the University Hospital in Marburg, Prof. Dr. Harald Renz says: "Our senior physicians confirm that the developed devices would be used as a 'last line of defense' for ventilation if you had no other option. We are currently well positioned in Germany. But there are other regions of the world in which one would certainly be grateful to use these devices in the ‘first line of defense’ as well. "

The team is currently looking for premises and financial resources for production.

Contact:
Prof. Dr. Martin Koch
Mail: breathing.project@physik.uni-marburg.de
Fachbereich Physik
Philipps-Universität Marburg
35032 Marburg

The CPAP-Approach
CPAP (Continous positive airway pressure)-ventilation is a common form of medical therapy when people suffer from sleep related respiratory problems like sleep apnoa. Worn at night, these masks keep the patients' respiratory tracts open by inducing a continous overpressure. CPAP units are available in large numbers in common households as well as in hospitals.
We have developed a method to extend a CPAP unit to a convenient non-invasive ventilation system to support a patient's breathing. This will help preventing problems due to a shortage of high-end ventilation systems.
To allow for a successful ventilation of a patient, different levels of pressure have to be applied during inhalation and exhalation. Our unit will be inserted between the CPAP unit and the air tube and allows tuning the provided continuous CPAP-pressure such that alternating levels of pressure are achieved.
Our solution consists of two components:
  • a) a small hatch

  • b) a microcontroller unit
The hatch is used to tune the pressure at the pressure mask by applying opening and closing sequences. A servodrive is controlled by a microcontroller to control this process. Our team has written the respective code to allow for a periodic opening-closing sequence and thereby supporting the breathing process as good as possible. Additional parts within our design will ensure that the pressure stays within a certain regime. Moreover, connections are planned which allow for a potential attachement to a direct oxygen supply.
Most of the components for our solution can be printed with a 3D-printer. Additional components, like the microcontroller and the servomotor, can be bought in electronics stores.
We have recently built our first working prototype to verify our concept and to test basic operations.. The prototype is shown in operation in the following video: youtube.com/video/RCZkSUAaGAo
A further test of our prototype can be seen here (as of March 21st): youtu.be/A6qe4ckgw8U
This video shows a test of our second, further improved prototype (evening of March 21st):youtu.be/xVVP6O_0aLg
Our newest prototype can be seen here (as of March 24th): youtu.be/OQiMXHRqIqg
We have already presented our prototype to physicians who gave us a positive evaluation of our design.
RE: CPAP use for Coronavirus mitigation & severe pneumonia
This is encouraging, but: it sounds like putting a servo device in line on a CPAP machine to get different pressures on inhale and exhale is just reinventing the Aircurve 10 VAuto or any number of competing bilevel machines.  Is there a difference here?  And what are the pressure settings?

From what I read elsewhere, consensus seems to be building for use of *PAP machines, frequently in combination with an oxygen bleed, as a way to keep the alveoli of the lungs inflated “just enough” in COVID-19 patients that are not yet severe enough that they require intubation.  This reduces demand for ventilators and helps flatten the curve.  

The medical community is suggesting PEEP of 16.

Does that translate to EPAP of minimum 16 in our terminology?  Because there are a whole bunch of unused CPAPs out there in a bunch of attics and closets that can Ben set to 16 if that’s all it takes.






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