CPAP use for Coronavirus mitigation & severe pneumonia

[Reznik]

Someone might want to watch these and report back:

https://covid19.sccm.org/nonicu.htm

https://covid19.sccm.org/Presentations/V...html?lms=1

https://covid19.sccm.org/Presentations/M...html?lms=1

https://covid19.sccm.org/Presentations/A...html?lms=1

[Sleeprider]

The wiki on O2 Oxygen Bleed described how to calculate dose. While O2 medical equipment seems to require a script, you can get pure oxygen from a gas supply store. There is not much difference in welding and medical grade, but you will need a regulator, tubing and interface. At this point medical oxygen cylinders are not in short supply. Be sure to understand the hazards and fire risk.

I think there is a lot of hope that the immune response can be suppressed by existing common drugs like hydroxychloroquine. It has also been correlated that individuals vaccinated for Malaria do not contract Coronavirus. Research into opportunities like this have bee fast-tracked to gather more data and determine efficacy if any so this therapy or prevention can be widely available very fast. The biggest factor we have in our favor is that, except for some notable hot spots, the virus is not widespread in the U.S. With the social distancing and travel restrictions enacted, it is possible or likely, that we will not overwhelm medical facilities in most of the country. All states have cases, but most have fewer than 100 known cases and precautions are widespread.

[mhehe]

According to the literature I have seen on Sars-Cov2 virus, it is essential to have Oxygen albeit at a relatively low rate. Even 2 LPM is enough to do the job. This is more important than the ventilator part if your case is not at the severe end. A person tested positive or has symptoms of Covid19 should use an oxygen concentrator set from 0.5 to 2 LPM.

[Reznik]

Has anyone tested to see how much of a pressure increase can be had by using two machines in series?  If not, and it is worth knowing, I have two machines so I can try to measure.

I doubt that the computer in the second machine would allow the pressure to go above the number stated on the display.  It probably just wouldn't have to work very hard to achieve that pressure.

[MichaelWD64]

I have central sleep apnea, so I'm on ASV plus oxygen. Here's a pic of how I attach my oxygen to my ASV at night. note the ox tube coming in near the bottom of the pic.

If I turned up the pressure on the ASV, I'd probably have to duct tape this here, and maybe on the ox box (oxygen concentrator) end, but I think this would end up closer to a ventilator experience than without the oxygen.

If you don't have a T-tube like that, I assume you could drill a hole in your big connecting tube, then seal off with epoxy or duct tape. (anyone know if epoxy is safe to breathe past after drying?)

But turn off oxygen before drilling, drills make sparks inside.

I assume the motor on this unit is sealed from sparks (would have to be), I've used this nightly with ox for 5 years no issues.

FYI, on oxygen and Bi-Pap I sleep like a baby on opium: deep, restorative, wonderful sleep.

FYI, I use ox on 2 liters during day, but 4 liters like this at night. It gets mixed with air in the process, and you lose some. So 4 liters through Bi-pap is like 2 liters direct. I've measured this with overnight pulse ox, and I'm not getting too much oxygen.

(not medical advice, blah blah. just my personal experience.)

Be well.

[ruthcatrin]

Well, you all have gone beyond me on the technical side.  But I can tell you that the cpap machine will absolutely help with at least mild breathing distress, AND makes it easier to notice said mild distress in the first place.  Even when you're awake.

Last spring I ended up in the local ER.  Final diagnosis was that I'd gotten massively dehydrated, they had to pump 2 liters of IV fluids (plus they kept handing me cups of water to drink) in me to get all my vitals back to normal.  

I'd been sick with a respiratory infection and most of the dehydration symptoms got ignored because of course I feel like crap, I'm miserable sick!  Till the morning I woke up, pulled off my mask, and instantly felt short of breath.  Put the mask back on and I felt fine.  With it off, I wasn't gasping for air, but I felt like I wasn't getting enough.  

So yah, I can see the possible utility for this purpose.

[rgmichel]

Some already use oxygen with their sleep apnea machines. I doubt they can replace ventilators, but they might help you keep your airways clearer for longer and help you through a bad patch of congestion. I doubt it will really see you through COVID-19, but my machine has seen me through many a cold for well over a decade now. I don't get as congested and my after-coughs clear up more quickly.

---

Has anyone tested to see how much of a pressure increase can be had by using two machines in series?  If not, and it is worth knowing, I have two machines so I can try to measure.

I doubt that the computer in the second machine would allow the pressure to go above the number stated on the display.  It probably just wouldn't have to work very hard to achieve that pressure.

I agree, the two machines would be working against each other and try to keep the pressure at the maximum of each machine.   One machine would win, randomly, and the other would go quiet.

[archangle]

My impression is that many of the lines of CPAP machines use the same hardware for different models and just change the software. 

For instance, the most basic manual CPAP with data machine is the same hardware as BPAP/BPap Auto/ASV/AVAPS and maybe even some of the "ventilators," such as NIV. 

We disassembled some of the older machines and looked at the service manuals, and many of the parts numbers of the guts are the same across models from midrange CPAP up through many of the higher level machines. 

I think this is true even for machines several generations back.

It seems to me that the manufacturer could quite easily turn some of the low/mid level CPAP machines into high level BPAP machines with just a software change.   One would hope the software can be updated in flash memory, but even if they had to replace ROM chips, it would be much easier than building a new machine from scratch.  If I understand correctly, the software is already written, you just have to put, for instance, the BPAP/ST software into the manual CPAP machine's program memory.  

There are many millions of unused CPAP machines out there.  People who quit CPAP, got newer or upgraded machines, people who died, etc.

Does this make sense? 

Should we try to get the government to build a fire under the CPAP manufacturers?  I suspect the manufacturers will be very resistant to the idea for various reasons.  They'd certainly need some sort of lawsuit protection and regulatory relief.  

These upgraded machines wouldn't be as good a "real" hospital grade ventilator, but they might well save a LOT of lives.

[archangle]

There would also be some questions of cleaning/sanitizing old machines, but in general, they don't really sanitize a used CPAP machine when they reuse it anyway.

You probably couldn't heat sanitize it, but you could probably use ethelyne oxide, as long as it doesn't eat circuit boards or plastic.  

Hey, you could just use one of those ozone cleaners they advertise so much.

[renard]

The negative study in community-acquired pneumonia does not argue against the use of BiPAPs in COVID-19. CAP is a different disease. All lung lesions are not created equal. The fact that COVID-19 patients are typically dying of organ shutdown on a more primary level, e.g. MI, kidney failure and/or stroke, not respiratory insufficiency, reinforces this. This disease in end stage triggers an overload of the body's immune response, that the organs cannot support, particularly in people with a higher viral load (not yet clear why some healthy people die; this is a hypothesis) or whose organs are already taxed, from smoking, diabetes, heart failure, vascular disease, autoimmune diseases, cancer, etc. 

I believe that some COVID-19 patients could benefit from BiPAP, and that higher IPAP max values as the Astral and Trilogy allow will not always be necessary to provide significant benefit. And from what we know, they should be reserved for those who need invasive ventilation that other BiPAPs won't support. 

I don't see how CPAP even with EPR could be helpful because without optimal PS, which 3cm is not, you are going to blow out lesioned lungs. The respiratory component of COVID-19 seems restrictive, essentially, not obstructive, so splinting the airway will only give the lungs more than they can handle. Of course, if the CPAP can be revamped to be a BiPAP S/T, that would be nice, but AVAPS/iVAPS would be optimal since volume control is the way to go. I don't know if the CPAP motor can run BiPAP parameters at all, though. After all, BiPAPs are bigger, for a reason, I'd think. 

Honestly, with the supply chain as twisted as it currently is, if you have a BiPAP to spare, I'd call the local hospital association all the way down to individual clinicians, and ask if they have ideas on how to get it into the hands of a unit that can use it. Or if your state or city has a leader who seems coherent, that person's office might be a starting point. Technically, the supply chain cannot accept used machines, as you know. The FDA could waive this in extremis but I don't see that happening.

Normally, I would be all for a unified effort but I'm afraid at present, it would be drowned out.