CPAP use for Coronavirus mitigation & severe pneumonia

[archangle]

Problem 5: You cannot eat while on CPAP. 

Can you eat while on a ventilator?  

This discussion is about whether CPAP machines can help in emergeny cases where a patient should be on a ventilator, but they're not available. 

I read it as being mostly about if the healthcare professionals (HCP's) could get some value from CPAP machines when ventilators aren't available.  i.e. "Your mom needs a ventilator, but we don't have one available."

No one here is suggesting keeping their loved ones at home and using CPAP if they need to be in the hospital on a ventilator. 

No one is suggesting to use a CPAP when a ventilator is needed, if a ventilator is available.


BTW, yes I CAN eat while on CPAP. 

When I read your post, I was actually eating my breakfast while using my CPAP machine.  I use a nasal mask and can eat, drink, and talk while CPAPing.

[seth]

I expect you're right Sleeprider but if there are no alternatives, which is what we're talking about here, I'm surely going to try it.  I've never had pneumonia but unless there's something that precludes it, I'll be using the machine anyway just as I always do. nor will I hesitate to offer it to my wife, children or neighbors if it's a last resort.

I couldn't agree with you more, sheepless. Every word. I was diagnosed 10 years ago with Combined Apnea (OSA & Central) as was prescribed a Resmed VPAP II STA with these settings (IPAP=18 cm;EPAP=13 cm) and have kept those settings with my VPAP III STA machine that I bought  to replace the VPAP II STA when it abruptly "bit the dust" I currently it use every night. I will definitely use it at last resort since I live alone and am at a higher risk, although no symptoms thus far.
My only question: How much should I change these settings, if necessary?

STAY SAFE everyboby

Seth

[abworld]

Re emergency Pandemic caused pneumonia & do it yourself emergency treatment for those unable to get hospital treatment:   using a CPAP machine is a logical emergency procedure, with 1000s already in place in the highest risk group. Personally, I just added a connection to my BiPap full face mask to connect an oxygen supply tank (which  I have in my welding system). My thinking is that the hospitals WILL be overwhelmed, & at minimum, I will have some measure of supplemental lung ventilation, & increased oxygenation, to at minimum help until I get to a hospital, or worst case, to provide this treatment when it is unavailable to me elsewhere.  I have a basic question:  What should the settings for a Bipap machine be in an emergency life-threatening pneumonia situation such as this?  -Thanks!

[SuperSleeper]

My only question: How much should I change these settings, if necessary?

I have a basic question:  What should the settings for a Bipap machine be in an emergency life-threatening pneumonia situation such as this?  -Thanks!

Hi Seth & abworld, this is exactly what this thread is hopefully going to accomplish.  Basically a standard protocol for adjusting our machines at home to act more like a ventilator, in a way that does not bring about more negative consequences over the positive ones.

Of course, supplemental supplies & equipment would have to be used in addition to CPAP when possible.


To repost a couple of examples from crowtor's post (HERE) and my post (HERE), this is just a start:

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

and

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:


1.  Turn up the CPAP pressure to the maximum (20, 25, or whatever the particular max pressure for that machine).

2.  If CPAP, turn on the maximum of C-Flex, A-Flex or EPR for comfort when exhaling.  Or adjust EPAP & Pressure Support accordingly for a Bi-level etc.

3.  Monitor blood Oxygen levels with a pulse oximeter on a regular basis.

4. Re-adjust max pressure, perhaps lowering it as long as SpO2 remains at least 92 or higher.  Leave it on max pressure if it's lower than that.

4. Use a full face mask if the pressure is too much with a standard nasal mask or nasal prong/pillows system so that the extra pressure doesn't simply escape out of the mouth while sleeping.  Or use a pretty strong chin strap to keep the patient's mouth closed.

5. When serious pneumonia comes, stay on the machine 24/7, or as much as possible.

6.  Utilize the "prone position" method when in bed to help with fluid drainage as much as possible.  

7.  If patient is able, use a "Lung Flute" or flutter type PEP device to help break up fluid and assist with productive coughing.  Or use other methods to help with productive coughing.


As always, I'm hoping folks will critique the above approach and add their own comments or suggestions and correct any misconceptions that I may have.

I'd really like us to come up with a standard protocol that people can use in a dire emergency situation when conventional medical help is no longer available.  Again, this is not the best-case scenario-- it's for a situation where we're forced to do the best we can with what we have on hand.

Of course, if Johnny Lee comes up with a way to modify the mechanics of a CPAP machine to force breathing with timed pressure increases, that might be better, but in the mean time, most people aren't going to have the mechnical skills to do what he is doing and will need simple advice on how to use their CPAP machine as-is to help with pneumonia as best they can.

I'm hoping others can take what was said in the above quotes and fine-tune things with a bit more detail for us.

[josephanzel]

Do people with sleep apnea fall in a more risky group if they get infected with sleep apnea? is sleep apnea a chronic disease?

[SarcasticDave94]

Are apnea patients more at risk? Possibly but I won't say definitely yes. Those with apnea, may have other health risks that apnea has opened the door to become more susceptible to other illnesses.

Is apnea chronic? Yes. It's not common for one diagnosed with apnea to be found in a state of not needing apnea therapy. It's chronic, as it's an ongoing health issue that in most cases will require therapy for the rest of one's life. As a medical descriptor term, chronic means a health problem enduring longer than 3 months.

[nite ranger]

Thanks for this thread, very interesting and thought provoking

[racprops]

Well let me start off with a few details: 71 will be 72 in July. Had a quad bypass in 2013.
 
Currently have hypertension which is well controlled by 5MG of amlodipine, and have not gone up in dosage sense 2013.
 
Was told during hospitable stay I had sleep apneas, was tested and told I have complex apnea  and was prescribed a ASV system.  I run a Respironics DS960HS and D950, I have found these systems seem to go buggy in 1.50 to 2 years; system will act funny and needs repair.
 
So my hypertension is well controlled by meds, and my only other real conduction is my sleep apnea. Which is also well controlled with a AVG of under 3 AHIs nightly, and I did my OWN set ups and adjustments. So I understand setting these systems up.
 
Question, as a over 70 male with mild problems what does it mean high blood pressure, is that even with it easily controlled am I still as high risk?

Also of note I have not had a cold or flu in about  5 to 7 years. And NO flu shots either. I did get the pneumonia vaccine a year ago as over 65 yearolds can get pneumonia and not have any other symptoms, which is why it is so deadly to over 65s.
 
So am I still at high risk??
 
More on subject apneas:
 
I was unable to get Medicare to even consider a replacement unit without a new sleep test, they then gave a DreamStaion APAP, it was no help so I bought a used rebuilt 950 for $250.00, from a CPAP repairman in north AZ. But he stopped doing CPAP. 

I then found a great CPAP repair shop here in Phoenix AZ; they can also rebuild a ASV system by replacing the mother board and fan for $250.00, so I had my 960 rebuilt.
 
For those with buggy systems they are: Medical Repair Systems  at 5160 W. Phelps Rd. Suite B Glendale AZ 85306 Phone 602-274-8584.
 
Buggy is ramping up when your falling asleep unneeded or over reacting during the night and pushing the pressure too high, again seemly unneeded. I have seen both a 950 and 960 do this at 1.5 to 2 years of 100% use.
 
I will offer my help into the ring;
 
Personally I feel an ASV system is the best answer due to it being able to respond NOW to a failure to breath. Thus the Servo Ventilator…along with the completely adjustable biflex, which can be set very low to allow easy exhaling.   I need both.
 
I too have OX in a welding system but one has to be very careful with setting for a low pressure output.
 
It is nice to learn I have such systems in place and that I had not thought of them as such use.
 
Thanks, I can breathe easier..pun intended…
 
Rich

[Boroma]

I made a couple of "just in case" buys a few weeks ago.
#1 An Oxygen adapter to go on my Airsense hose.
#2 A cheap Oxygen generator from Ebay.
#3 A pack of nasal cranulas.
I tried them. They make a small difference, probably because the generator only concentrates to 28%. Better than nothing?
I understand that there are quite a few medical grade concentrators (to 90%?) available. The only necessary item to add oxygen is the adapter. I'd suggest we should consider getting one, just in case.
I'm hoping that it could keep me alive if I caught something long enough to get me into a hospital.
I was taking a walk in my local park last week and came across some exercise equipment installed by my local council. I tried it and notice an improvement in my respiration afterwards.

[seth]

My only question: How much should I change these settings, if necessary?

I have a basic question:  What should the settings for a Bipap machine be in an emergency life-threatening pneumonia situation such as this?  -Thanks!

Hi Seth & abworld, this is exactly what this thread is hopefully going to accomplish.  Basically a standard protocol for adjusting our machines at home to act more like a ventilator, in a way that does not bring about more negative consequences over the positive ones.

Of course, supplemental supplies & equipment would have to be used in addition to CPAP when possible.

SuperSleeper,
Thanks for all the information in your reply above you wrote:
"Basically a standard protocol for adjusting our machines at home to act more like a ventilator, in a way that does not bring about more negative consequences over the positive ones".
Funny thing is according to Resmed (I believe on the description of my machine (VPAP III ST-A), it is classified as a VENTILATOR. Based on its mode of operation and what I've read as the definition of a ventilator, this appears to be the case.
As this being what it is, I feel truly lucky to have kept this old "friend" and am using it every night for the past 10 years despite its data reporting limitations (like can't give me an AHI). It seems its reporting capability is focused on compliance data.
So, my interest in pressure numbers for it re: pneumonia "treatment" at last resort at home is important since I could some what realistically substitute it for a hospital ventilator again at last resort
Thanks again for this wonderful thread and I think I need to be on AB more often
Seth