CPAP and other respiratory issues

[Johnboy]

With the coronavirus pandemic, and the science stating that the major risk is the onset of respiratory issues including pneumonia. Many of us won’t have underlying health issues and i am not aware that OSA is a risk factor. However, given the claimed shortage in respirators, i am wondering if there is any evidence that CPAP can assist with respiratory issues such as pneumonia?

[Gideon]

First there are 2 definitions of CPAP.
1. A machine that provide fixed constant pressure
2. All machines, including CPAP, APAP, BiLevel wo backup, BiLevel w backup, ASV, AVAP, etc.

ALL of the above improve breathing, but none of the above are designed to treat pneumonia and none of the above are a replacement for a hospital grade ventilator.

When I am sick and congested, not pneumonia, I use my machine all the time, but them I'm one who will rest in bed for 24+ hours, eating little to nothing until I throw it. I feel it helps me through it.

Recommending CPAP as part of a treatment for the Corona virus, no, I can't and will not do that.


If you have OSA or CSA I do recommend that you use your pap machine through any illness that you have unless you are put on a higher level, more capable machine.
Also consider that my untreated AHI is 77-93 based on two different studies.

[Johnboy]

Bonjour - thanks for the reply. I wasnt suggesting that it was in any way a replacement for a respirator but was wondering in the circumstances that someone had respiratory diffculties whether PAP was better than nothing?

My non treated AHI was 52

[Sleeprider]

Enjoy!  https://www.sciencedirect.com/science/ar...4114004043

The role of noninvasive positive pressure ventilation in community-acquired pneumonia

Abstract
Background
Despite the increasing use of noninvasive positive pressure ventilation (NIV) in the treatment of critically ill patients with respiratory failure, its role in the treatment of severe community-acquired pneumonia (CAP) is controversial. The aim of this study was to assess the use of NIV in patients with CAP requiring ventilation who are admitted an intensive care unit.

Methods
A retrospective cohort study of all consecutive patients admitted to 3 tertiary care, university-affiliated, intensive care units from January 2007 to January 2012 with the principal diagnosis of CAP and requiring positive pressure ventilation was carried out. The primary outcome was acute hospital mortality. Univariable and multivariable analysis were performed to assess the association between mode of ventilation and death as well as factors associated with failure of NIV.

Results
A total of 229 patients were admitted, with 20 patients excluded from the analysis because of do-not-resuscitate orders. Fifty-six percent of patients were initially treated with NIV. Of those, 76% failed NIV and required intubation and invasive ventilation. After adjusting for confounders, no difference in mortality was seen between patients who received NIV as first-line therapy in comparison with patients who received invasive ventilation (odds ratio [OR], 1.63; 95% confidence interval [CI], 0.81-3.28; P = .17). Multivariable analysis demonstrated a trend toward increased NIV failure for the patients who had higher Acute Physiology and Chronic Health Evaluation II scores (P = .07) and vasopressor use at 2 hours after initiation of positive pressure ventilation (OR, 7.5; 95% CI, 1.8-31.3, P = .006). In an adjusted analysis, patients who failed NIV had an increased odds of death when compared with patients who were treated with invasive ventilation (OR, 2.2; 95% CI, 1.0-4.8; P = .03).

Conclusion
Noninvasive pressure ventilation is frequently used in CAP but is associated with high failure rates. Mortality was not improved in the group of patients who received NIV as first-line therapy despite clinical characteristics that might have suggested a more favorable prognosis. Given the high rates of NIV use, high failure rates, and the hypothesis generating nature of the data in this study, further randomized studies are needed to better delineate the role of NIV in CAP.

[Johnboy]

That would be a science based resounding no then - lol

[Sleeprider]

That would be a science based resounding no then - lol

Well, more study was recommended to identify an appropriate role for non-invasive ventilation in community acquired pneumonia.  I think the cohort reflects critically ill individuals and other than excluding those with no resuscitation orders, this might not reflect the population that might benefit.  I think more mildly ill individuals could expect better comfort, but with this cohort, NIV failed to make a difference in whether they moved to invasive ventilation or mortality.  Not too encouraging.