CPAP use for Coronavirus mitigation & severe pneumonia

[DesolateSleep]

Oh, I agree it won't be for the current users. This is either forced on them because options run out or they figure out that money will be made in the gaggles. I'm counting on irrational greed under the guise of helpfulness to get us what we need. Barring that deaths  or the threat of deaths in large enough numbers to drive governmental interventions.

Didn't want to say all that earlier but...

[thomasschon]

Take a look at this youtube move watch?v=okg7uq_HrhQ&t=306 
(I'm sorry, I am a brand new members are not allowed to post links in this forum until I have made 4 posts.)

This one is important I think.
It's better to use the ventilator in CPAP mode with a continuous pressure to stop the alveoli from collapsing and to keep them open.

It was called a Low tidal volume strategy and creates a lot of CO2 but lowered the mortality from 40 % to 32 %

Then they added paralyses to stop people from resisting the increasing CO2, but this is an advanced thing to do.
They were able to drop the mortality from 41 % down to 31 %

They tried another approach by flipping the patients over from their backs to their stomachs.
It's called prone positioning and it lowered the mortality even more.
The mortality went down from 33 % to 16 %

Here's a link to the description. I think I got it from this forum but when you talk about using Bipap mode I didn't know if you watched it.
A youtube url and this video v=okg7uq_HrhQ&t=306

[SarcasticDave94]

A very important note with regards to the current coronavirus situation: every road we take will always include 2 ditches, one on either side. Crashing into either side's ditch causes nasty side effects like pain, bodily injuries, injury or casualties inflicted upon others, increases to insurance premiums, increased fear or worry it may happen to you, and other similarly bad things.

This, however, will happen only if you swerve off the road of sane, reasonable thinking and crash into the ditches of over or under caution, and the other related problems associated with either respective ditch.

The moral: keep the shiny side up and always keep things on the pavement.

This public service announcement was brought to you by SarcasticDave94.

Good night folks, and be safe.

[DeepBreathing]

Hi thomasschon. Welcome to Apnea Board. Your links aren't working and a search of YouTube returns a zero result. Please tell us the full name of the video in question. Once we have that I can put up the correct link.


Question - does this video add anything to the dozens that members have already listed?

[Robert Dwight]

I have a report on the characteristics of the hospital grade ventilators that describes the workings of the ventilators, the report is a pdf i made of the table 3 of the report compiled by JKMS korean medical science. but there are many reports on the requirements of ventilators they will show up in google search words "Characteristics of Mechanical Ventilation"

[thomasschon]

Hi thomasschon. Welcome to Apnea Board.  Your links aren't working and a search of YouTube returns a zero result. Please tell us the full name of the video in question. Once we have that I can put up the correct link.


Question - does this video add anything to the dozens that members have already listed?

[rdbFamily]

sleeprider says  "Some people theorize that NIV might help the outcome of critically ill patients with pneumonia.  So far that theory remains unsubstantiated as described in teh article below." 
I'm not sure how you are interpreting what the study shows.  The logic of that study is as follows: take a group of patients with community acquired pneumonia and have some of them try non-invasive positive airway pressure therapy first, while others go straight to intubation and ventilator use. The result was no difference in mortality between the two groups.  So, a. it showed no demonstrable harm in trying non-invasive first; but, b. 76% of noninvasive patients ended up on ventilators anyway. 

with regard to the current thread, the take home message is:
1. obviously, if ICU beds and ventilators are available, then by all means, if you need one, get one.
2. if we haven't flattened the curve, and like Italy we end up turning people away, then, by all means, use your xPAP and hope that you're in the 24% (100-76%) who can make it without a ventilator!
3. the point of the thread is this: are there modifications we could make to our xPAP that do better than the 'standard' settings for CPAP used in this study to bump that percent up from 24% to something higher?  Standard ARDS protocols call for prone positioning, so consider setting up a place in your home where you can comfortably spend time face down.  Avoid over-hydration, again standard ARDS protocol is to minimize pulmonary edema by maintaining a net neg fluid balance. Oxygen is important, obviously, but ridding your body of CO2 (ventilating) is equally important, and so minimize your work load while ill so you aren't generating lots of CO2 and  BiPAP helps reduce the workload of breathing, so if it's an option, it might be preferable to CPAP. Use your machine 24/7 if you get to that point so that the constant PEEP can minimize atelectatic loss of FRC. 

rdbFamily, MD

[Pirate11]

A couple of questions for those that know more than me.

What pressure do ventilators normally work at?

As I perceive an issue with some of the masks sealing under higher pressure can we come up with a DIY solution to this?

Are some masks better than others on higher pressures? If so, which ones?

Can we get a software update offered that may allow access to higher pressure levels than the current 20mg?

My questions are more to guide some of the smart people on this forum to use their intellect...or common sense or knowledge.

[geauxdbl]

Just found this from a week ago in the Lancet:


https://www.thelancet.com/journals/lanre...2/fulltext

The level of positive end-expiratory pressure can be increased by 2–3 cm H2O every 15–30 min to improve oxygen saturation to 88–90%, with the goal of maintaining a plateau airway pressure of less than 30 cm H2O. Lower driving pressures (plateau airway pressure minus positive end-expiratory pressure) with a target of 13–15 cm H2O can also be used. If the patient is not responding to adjustment of the level of positive end-expiratory pressure, additional strategies might stabilise them.

That helps establish a target pressure range to start from.  EPAP of 15 and lying prone sounds pretty straightforward.

[Pirate11]

Good information there.

I am not sure about other modes of treatment however my understanding is that CPAP is breather determined.  With ventilators, some prescriptions require breathign rates of 30-35 breaths a minutes and higher. 

Are there any program overrides that can help us with controlling breathing for a user under these extreme situations?