CPAP use for Coronavirus mitigation & severe pneumonia - Printable Version +- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums) +-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area) +--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum) +--- Thread: CPAP use for Coronavirus mitigation & severe pneumonia (/Thread-CPAP-use-for-Coronavirus-mitigation-severe-pneumonia) |
RE: CPAP use for Coronavirus mitigation & severe pneumonia - GWild - 03-20-2020 According to available resources, NIV (aka xPAP) is not suitable due to the simple fact fluid builds up in the lungs. Air can't get in unless you first remove the fluids. And worse, even if you receive intubation or direct gas infusion into your blood to maintain O2 levels, the outcome is still not good. Brain damage is common. Everyone should read the Imperial College paper published 20200316: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand Bottom line is that with every measure that is being taken or likely to happen, 80% of the population (specifically UK and US) will be infected within the next 12 months. I have a living will that states absolutely no intubation. Instead, manage pain and let me die a natural death. I am glad I had this document drafted years ago. I might need to use it soon. [attachment=21219] pps: Mother in-law died recently, she was given APAP to maintain her airway her last days, but she had no other lung problems like pneumonia or congestion. She died shortly after they removed her from APAP. RE: CPAP use for Coronavirus mitigation & severe pneumonia - Sleeprider - 03-20-2020 Lots of discussion in the past page about the use of ASV and the relevant studies. They are SERVE-HF and ADVENT-HF. if you are searching. I think the 2015 guidance that restricted ASV for patients with LVEF less than 45% likely deprived many individuals of more effective and gentler therapy, as well as caused many physicians to mis-prescribe ST machines to healthy central and complex apnea patients. I can't wait for it to be withdrawn. We have a pretty good wiki on using an Oxygen Bleed with PAP (I'm too modest). http://www.apneaboard.com/wiki/index.php/Oxygen_Bleed_with_CPAP If you like math, you're going to love it. RE: CPAP use for Coronavirus mitigation & severe pneumonia - SuperSleeper - 03-20-2020 Again, GWild, you may wish to go back and read the entire thread. We're not talking about what is "Clinically recommended" here. We're also not talking about what is considered a proven "safe" or "standardized" treatment in a modern medical clinical setting where better alternatives are freely available and plentiful. Instead, we're talking about "ditch medicine" for a future time when there is no available hospital beds or ventilators and the elderly are simply told "go home and do the best you can" (austere triage) where only the younger with the best chance of survival are put on the limited supply of ventilators. If a loved one is dying and can't get professional health care, I'm going to everything I can to mitigate their pneumonia and not simply watch them die because some professional scientist in some far-away university had a study that indicates using CPAP for COVID-19 treatment might have some unwanted side-effects. In other words, we're talking about a dire, worst-case scenario here, not dealing with patients who still have access to traditional modern health care facilities. Please go back and read my post (HERE), which stated: Quote:What we're talking about here is helping someone who is on their death bed. They already have severe pneumonia; they are going to die without someone stepping up to the plate and thinking of ways to help. Perhaps methods that modern conventional doctors and hospitals would frown on as being "primitive and risky". RE: CPAP use for Coronavirus mitigation & severe pneumonia - Reznik - 03-20-2020 Setting aside ditch medicine, consider also that CPAP might effectively prevent some people from ending up in a critical care setting in the first place. Since CPAPs are medical devices and cannot be used by people who are merely sick and not in a hospital (except for sleep apnea users), there probably aren't any studies showing whether they are effective at an earlier stage of the disease. RE: CPAP use for Coronavirus mitigation & severe pneumonia - GWild - 03-20-2020 I do understand the reason for the thread. But no one has mentioned the serious issue facing those who seek a hospital bed in the first place: they can't breathe. This is most common fluid build up. How does a CPAP help in that dire situation? Can it help in that situation? While if I am in that situation I'll certainly play with settings as much as I can, the physical constraints of non-compressible fluids versus an air-pump are pretty clear. Maybe if I also had my inversion bed to let fluids drain via gravity? I tend to be realistic when confronted with inconvenient facts, so I come off as harsh and insensitive. I'm not. And let's be clear, I am in the same boat as anyone else who will also need acute hospital care. And I am all in for asking the question if there are any hidden capabilities in our gear that might be of use in the coming days. RE: CPAP use for Coronavirus mitigation & severe pneumonia - GWild - 03-20-2020 @reznik, keeping airways open has helped me when I'd had significant congestion. Nothing nearing pneumonia, but chronic nasal congestion that would normally turn into a chest infection has been pretty much averted now that I am on PAP. I still get the drips, but the resulting chest problems have pretty much gone away. Anecdotal, but still a data point. Also, since this will be viral, COMOX won't be helpful. Here's a piece that discusses home care for pneumonia. https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/pneumonia/treatment-and-recovery.html Anyone have a "last ditch" solution for home O2 generation beyond a PSA or splitting water? i.e., compressible O2 we can bottle safely. RE: CPAP use for Coronavirus mitigation & severe pneumonia - SuperSleeper - 03-20-2020 (03-20-2020, 08:28 PM)GWild Wrote: I do understand the reason for the thread. But no one has mentioned the serious issue facing those who seek a hospital bed in the first place: they can't breathe. This is most common fluid build up. How does a CPAP help in that dire situation? Can it help in that situation? While if I am in that situation I'll certainly play with settings as much as I can, the physical constraints of non-compressible fluids versus an air-pump are pretty clear. Maybe if I also had my inversion bed to let fluids drain via gravity? Yes, they have mentioned that in prior posts. Go back and read the entire thread. We've discussed the issue of fluid buildup. Even the post I made a few days ago and re-posted again today suggests a possible protocol which includes preventing fluid build up using the prone position method and a PEP device: http://www.apneaboard.com/forums/Thread-COVID-19-CPAP-use-for-Coronavirus-mitigation-severe-pneumonia?pid=341045#pid341045 We're trying to come up with an approach that addresses all of these issues. It's not simply using CPAP alone. For the third time, I'll re-post that 7-point protocol here, which is only intended to be a starting point for discussion and fine-tuning, based upon our collective knowledge: SuperSleeper Wrote: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: RE: CPAP use for Coronavirus mitigation & severe pneumonia - Reznik - 03-20-2020 Well, if CPAP won't help when there's fluid, how would a ventilator help? Neither actively remove fluids. RE: CPAP use for Coronavirus mitigation & severe pneumonia - Reznik - 03-20-2020 I continue to believe that if there's a role for CPAP, its in helping people to breath *before* they become critical and need hospital treatment. RE: CPAP use for Coronavirus mitigation & severe pneumonia - SuperSleeper - 03-20-2020 (03-20-2020, 08:40 PM)Reznik Wrote: Well, if CPAP won't help when there's fluid, how would a ventilator help? Neither actively remove fluids. Bingo. Both CPAP use and ventilator use needs to be supplemented with methods to help remove fluid in the lungs. We're not talking about using CPAP alone in this thread. We need a complete protocol for emergency use only, and that protocol would likely include a variety of pneumonia-fighting tools, including possible CPAP usage. |