CPAP use for Coronavirus mitigation & severe pneumonia

[DeepBreathing]

If I can help, then please let me know. I am the regional manager of a sleep apnea/home oxygen company in BC, Canada (RRT FCSRT. PSGT). I deal specifically with IVAPS, CPAP, APAP, BiPAP, AVS, and home ventilation, as well as home oxygen provider under the HOP of British Columbia. Been doing it for over 25 years, in 3 different countries, as well as a plentiful enough experience in critical care. Thanx!

Hi Danceswithpike

Given your experience and expertise, do you have any comments on the types of schemes that people have been coming up with? In particular the use of CPAP / APAP / Bilevel / ASV machines as a ventilator to support breathing in a last resort situation when hospitals are full and every "real" ventilator is allocated?

Intuitively I would think a bilevel with backup rate set to maximum pressure support would be the way to go. But I've seen papers indicating that low pressures and small tidal volume is a better approach.

[FJD]

How is well water for bacteria?? Viruses? Does leave hard water deposits on tank of course. Vinegar gets em off though.. of late, ive left tank dry. Fewer mouth bugs since going dry. Tongue gets real dry sometimes.

Well water will be variable with respect  to bacterial content. The greatest  risk is for enteric pathogens due to fecal contamination from improperly sealed wells, improperly functioning septic systems, drainage from animal waste, etc. This is a risk for shallow wells but probably not for deep wells. Bacteria that cause respiratory infections are unlikely to be found in well water. Pathogenic bacteria are unlikely to grow in well water because of lack of nutrients. Viruses, especially coronavirus are very unlikely. In most cases the risk of chemical contamination is worse than microbial.

Hi,

Please kindly remind :

Legionellosis stands in well water.
This is a major pathogenic concern.

Virus COVID stand in aero carryed droplets and stay more than 4 hours on wet surfaces...

To provide thmild water condition to a medical support device have to be concidered with most care...

FJD

[Melman]

From CDC https://www.cdc.gov/legionella/about/cau...ssion.html
“Causes and Common Sources of Infection
Legionella is a type of bacterium found naturally in freshwater environments, like lakes and streams. It can become a health concern when it grows and spreads in human-made building water systems like
• Showerheads and sink faucets
• Cooling towers (structures that contain water and a fan as part of centralized air cooling systems for building or industrial processes)
• Hot tubs that aren’t drained after each use
• Decorative fountains and water features
• Hot water tanks and heaters
• Large plumbing systems “
Well water isn’t mentioned but it may be possible source; but in low numbers that are not a threat.

Many long term members of this forum have found that any water that is safe to drink is safe for use in CPAP humidifiers.

Again from CDC “Most healthy people exposed to Legionella do not get sick. People at increased risk of getting sick are:
• People 50 years or older
• Current or former smokers
• People with a chronic lung disease (like chronic obstructive pulmonary disease or emphysema)
• People with weak immune systems or who take drugs that weaken the immune system (like after a transplant operation or chemotherapy)
• People with cancer
• People with underlying illnesses such as diabetes, kidney failure, or liver failure”
Many of us are probably exposed to legionella but the disease is fairly uncommon.

[bhindley]

1) 
I haven't found a cpap/bipap machine yet that I couldn't get into service mode by simultaneously pressing the power button plus some other button(s). I have done this with a variety of these machines that I have bought cheaply in thrift stores. Typically you can also find and download the clinician's manual online for free.

2)
I am considering wearing my headgear/mask along with goggles to protect myself when grocery shopping in public. The object is to avoid touching my face with contaminated hands (99% of how to get infected). Easily wiped down after use.

[slowriter]

This video from an ER doc in NYC mentions they are using CPAP machines. It sounds like they are using them for less extreme cases, so they can prioritize the ventilators for the worst patients.

https://www.nytimes.com/video/nyregion/1...d=tw-share

It occurs to me that it might even be a good idea for anyone that does get sick and needs to seek emergent care to bring their xPAP machines with them?

[bhindley]

I keep a spare  machine in a go bag for emergency use. I also have a battery backup setup for power failures.

BTW, that NY Times link doesn't work.

[FJD]

Just as important as not self-medicating with a malaria drug for parasites, good intentions can relay bad and harmful information. Knowledge is key and we all have the ability to help broaden delivery of reputable free key classes to learn from regarding this Coronavirus. BE SAFE!

Hi,

The problem with self-medication is not the product (hydroxychloroquine) whitch is a well proved antiviral and intra cellular anti bacterial drug.

The problem is when people say "I have a coï fish treatment with chloroquin-sulfate, lets take a cup of that..."


The recomanded dose is 600mg for ONE DAY (3x 200mg caps) and not 6 grams in a spoon for one take.
Quinin is one of the best known medicine all over the world as it treats malaria, was take by more than 1 Bilion people aroud the world during 30 years long.
Secondary effects are very small and documented.

But might you take the risk when your life is not endangered ?

Lets take the problem in reverse side :

Tea, coffee, any plants on the world with medicine effect can carry side effects.
Do we refuse a tea or a coffee because it might be wrong for your health ?

Having a cat do not affect anybody althougt we are not allergic.
Eating a tea with quinquina is like having a gin-tonic (invented to ease the swallow of very unpleasant taste of quninquina)

who would take 6g of pure cafein in a spoon alleguing this will help to be awaken ?


In my opinion, some people are just foolish this drives to natural selection, like peeing on electic, getting head out of the train or the car, put heat in lion mouth...

FJD

[Robert Dwight]

Hi SuperSleeper It sounds like a feasible statement. I downloaded some info on the characteristics of a hospital ventilator (attached with this note) . Obviously the CPAP machines don't have all the digital monitoring screens of the ventilators, so monitoring of the person will have to be taken care of by pr officiant  persons, but if we get to a stage as you suggest may happen, then maybe someone could explain the monitoring that may be required.

[Gwenmey]

Thank you so much for this post.  Great thinking as we get into this pandemic further.  I'm going to see what info I can gather about using a CPAP for pneumonia.  I have a friend who is a respiratory therapist and I'll ask her. If you look long enough online you can find the instructions for changing your pressure. That may be something we'll need to know.

[FJD]

From CDC  https://www.cdc.gov/legionella/about/cau...ssion.html
“Causes and Common Sources of Infection
Legionella is a type of bacterium found naturally in freshwater environments, like lakes and streams. It can become a health concern when it grows and spreads in human-made building water systems like
   • Showerheads and sink faucets
   • Cooling towers (structures that contain water and a fan as part of centralized air cooling systems for building or industrial processes)
   • Hot tubs that aren’t drained after each use
   • Decorative fountains and water features
   • Hot water tanks and heaters
   • Large plumbing systems “
Well water isn’t mentioned but it may be possible source; but in low numbers that are not a threat.

Many long term members of this forum have found that any water that is safe to drink is safe for use in CPAP humidifiers.

Again from CDC “Most healthy people exposed to Legionella do not get sick. People at increased risk of getting sick are:
   • People 50 years or older
   • Current or former smokers
   • People with a chronic lung disease (like chronic obstructive pulmonary disease or emphysema)
   • People with weak immune systems or who take drugs that weaken the immune system (like after a transplant operation or chemotherapy)
   • People with cancer
   • People with underlying illnesses such as diabetes, kidney failure, or liver failure”
     Many of us are probably exposed to legionella but the disease is fairly uncommon.

Indeed.

And what about fragilized lung of whom are COVID 19 in CDC condition of use for tap water ?

Any support with wet condition make germs reproduce. And heat multiply exponetially the grow.
This is in every clinician manual no ?

What is the humidifier box if not a wet AND heat condition ?



The resmed manual warn against puting anything in water bowl (like essential oils : chlorine : vinegar / etc)

The same manual insist with need to purge, wash and dry the bowl each morning,
The same manual insist about washing pipe everyday

But who cares ? Do you really wash your circuits every day ? (for my part I don't)


This is only for normal conditions with people in Apnea syndroms forms not with lung diease.

For my part I no more use moisturing / humidifier bowl of CPAP.

Air we receive has nothing to see with medial dried air from hospital circuits. This air is the same that we breath in the room we stand. If feeling unconfortable with it, humidify the room is the solution, not the CPAP.

When I used humidifier (in winter as air is dryer in cold contitions) I had water in the pipe. This is not safe conditions.


To reply to someone whom experiment dry tongue at wake up :

This is mostly certainly because your mouth is open AND the CPAP pulses air directly in short circuit from nose to mouth... IMHO maybe should you try a chin strap, something like :

cdn.shopify.com/s/files/1/0021/7422/2394/products/New-Neoprene-Anti-Snore-Stop-Snoring-Chin-Strap-Belt-Anti-Apnea-Jaw-Solution-Sleep-Support-Apnea.jpg?v=1558099693

talk to you local CPAP provider or your specialist about it.


Anyway for me humidifier is not a good idea and especially for using CPAP in vent for COVID disease.
I alway balance benefice-risk, whaterver the fewest risk with a fresh and pure tap water changed every day. If humidity has any effect upon germs promotion, I would not use it. as simply as that.

Until a medical advice say the opposite...

Do anybody have a link to any publication about humidity meed in COVID vent ?

FJD