CPAP use for Coronavirus mitigation & severe pneumonia

[dottore]

I've been thinking about this same possibility for several days now, so I'm very happy to learn about this thread.

Just one quick caveat before I start. I am not up on all the latest CPAP technology. My apnea is mild and I don't need any of the fancier systems. Unless I have a cold, I use straight CPAP with a minimal amount of CFLEX. So what I'm about to say might be contradicted by th current state of the art. If so, I apologize.

I agree with those who posted that a CPAP (of any variety) increases breathing efficiency. As someone posted, it can be very helpful when you have a cold. In my case, it almost always completely relieves my breathing problems when I have a stuffed up nose. I just increase the pressure a couple cm and set the CLFEX to the max and I can breath while I lie down. It's made a huge difference in how my body handles a cold.

It also seems like a CPAP could be configured to administer oxygen. When I started CPAP a couple decades ago my mask had ports. They could be used for administering oxygen. My current mask doesn't have ports and I'm not even sure that masks with ports still exist, but it shouldn't be hard to connect up an oxygen tank to a hose or maybe directly to the machine itself. My machine doesn't have any way to connect up a tank, but I'll bet there are some out there that do. Even if there aren't a little creative plumbing and a pressure regulator could do the job.

So I don't know if CPAP can be helpful in the case of a severe COVID-19 infection. But it seems like something worth considering. SO thanks for starting this discussion.

[SarcasticDave94]

Two of the most popular model lines, the ResMed AirSense and AirCurve 10 Series and the Respironics DreamStations should both have an optional hose that has a hose bib at the machine end for accepting an oxygen hose. This is definitely true for the ResMed devices.

Example of the ResMed ClimateLine Air Heated Hose with Oxy

[attachment=21218]

[ardenum]

As far as I know the current proper ARDS protocol is:

1.low Tidal volume ventilation(invasive)
2.laying on the stomach
3.paralysis(injection) to comply with the ventilator.

Omitting the last one, the first 2 are somewhat achievable on our machines.

My source: https://youtu.be/okg7uq_HrhQ?t=306
Other more scientific source: https://youtu.be/14NbqW_xf2U

Regarding CPAP's and BiPAP's in context of ventilation http://www.anaesthesia.med.usyd.edu.au/r...ation.html

[ckingzzzs]

It is funny because when I saw this post I figured sleeprider was a good person to respond and did in fact respond with good information.

I just wanted to mention as well, I believe RESMED came out with a notice not too long ago about the dangers of using ASV machines with a low ejection fraction ratio of the heart.  Since many older people likely suffer from or have a lower ejection fraction ratio, using an ASV machine might pose a problem for these people.

just a thought

[sopherFellow]

In addition to what SuperSleeper mentions above, 
What can OSCAR do to help during this Pandemic?

1. Maximize the info you can get from your device. (I think OSCAR does this OK)
2. Distribute OSCAR for free (Always)  AB is conducting a donation drive which helps with this, any donations are appreciated.

what can OSCAR do that we are not currently doing?  What are your ideas?

Fred,
This would seem to be a great time to incorporate easy importation of more O2 monitors, like the O2 Ring and others.
Dennis

[Gideon]

That study is much disputed and a newer study is in the works that should remove that restriction.
Would it surprise you that CHF sufferers who did not maintain compliance on an ASV had a higher mortality?

[Reznik]

I wondered about this subject and so I did a bit of research and then spoke with several physicians about this question.

Apparently, it is quite common to use CPAP and/or BiPAP (Non-Invasive Ventilation or NIV) to treat respiratory distress in ER and ICU before proceeding to invasive ventilation.

The articles that I've found indicate that they typically start CPAP at 5.0 and move up in 2.5 increments up to 10.0.  For BiPAP, they typically start at 10.0 IPAP and 5.0 EPAP.  If you have a typical ResMed Machine, you can set your machine at 8.0 with EPR 3 and you essentially have Bi-level at 8.0/5.0.  Of course, all of these numbers presume someone who is awake and doesn't have sleep apneas.  If you're not conscious and have sleep apnea, then I have no idea what they would do.

I have personally found that when I'm sick or have the flu, I need to bump up the pressure in order to breath comfortably and get to sleep.

My conversation with several physicians revealed that typically they won't use NIV (CPAP/BiPAP) unless they've tried supplemental oxygen first, and were unable to get oxygen saturation to normal levels.  When they add NIV, they use supplemental oxygen as well.

Since we generally don't have the ability to add supplemental oxygen to our CPAP, I concluded that while our CPAP or BiPAP might offer minimal benefit, without supplemental oxygen, it probably won't keep us out of the hospital.

I should also add that the claim that COVID-19 is increasing exponentially in the US is not being born out by the number of hospitalizations or deaths.  The number of positive tests IS increasing exponentially, but that is because the number of tests being performed is increasing exponentially.  The claim that there is no treatment is also not accurate.  The Chinese tried a variety of treatments, and there are several that were found very promising and are being used at U-W Medical Center and elsewhere in the US.  

I strongly encourage everyone to read the Canadian government's update on COVID-19.  It provides a great deal of data resulting from Canada's 54,000 tests over several weeks, including hospitalization rates, positive test result rates, and other data which American health authorities are not providing.  I find the data very reassuring.  While this is a very serious situation, we all have a good chance of avoiding the worst if we take action now.  Stay home.  Wash your hands.  Watch TV (but not the news).

Look here:
https://www.canada.ca/en/public-health/s...id-19.html

https://www.canada.ca/en/public-health/s...c=tilelink

and here:

https://www.canada.ca/en/public-health/s...ases.htmll

[SarcasticDave94]

It is funny because when I saw this post I figured sleeprider was a good person to respond and did in fact respond with good information.

I just wanted to mention as well, I believe RESMED came out with a notice not too long ago about the dangers of using ASV machines with a low ejection fraction ratio of the heart.  Since many older people likely suffer from or have a lower ejection fraction ratio, using an ASV machine might pose a problem for these people.

just a thought

The LVEF notice has actually been out for some time. There are several aspects of the study that created a flawed outcome. There is a new study to be released soon that replaces the current one. Apparently, this newer study was done more correctly and does have more appropriate outcomes.

I myself had to take the cardio echo test to pass the LVEF of a minimum of 45% to get my ASV. I had a 55% LVEF at the time I tested about 3 years ago.

[SarcasticDave94]

I am sure I've mentioned it elsewhere on AB, but most of today's CPAP machines can accept oxygen with a unique hose with a built-in oxygen hose bib. While that unique hose is readily available, having an oxygen source at home is not.

[braindead]

Phage Therapy - The Virus That Kills Drug-Resistant Superbugs

I first heard about it many years ago. It was/is used in Russia and surrounding countries but medical arrogance has prevented its use in the West.

https://www.youtube.com/watch?v=aVTOr7Nq2SM

John