CPAP use for Coronavirus mitigation & severe pneumonia

[dbainbr]

I don't understand the special concern with CO2 removal. We've all been using these things for a while, or we probably wouldn't be on this site. Yes, lungs with pneumonia will have less volume to be compressed then released, but why would that make CO2 a problem?

[SarcasticDave94]

Having gone through a bout of pneumonia last July, and having COPD as well, I'll venture to give possible insight into why the concern for CO2 removal, AKA exhaling in a near normally efficient manner, which requires one to realize how we exhale in normal circumstances. I'm not playing Dr. Dave and go into all the aspects, but I want us to focus on the very basic thought of "how do we exhale?".

Let's start with the opposite though. Inhalation is powered by the diaphragm flattening and creating negative pressure on ones lungs as I recall it. This pulls air into your lungs. Then to exhale, it means your diaphragm relaxes and this pushes the air out of your lungs. Letting air out of an inflated balloon is how I visualize this as happening. Without restriction or obstruction, exhalation doesn't require force or pressure like or equal to inhaling. That changes when there's a restriction such as what COPD, asthma, pneumonia, and others similar ailments add to the exhalation process. All that CO2 is not escaping as it once did.

Maybe I have this right or maybe not. But I can see restricted breathing as an issue that traps CO2, because I deal with adding force to exhale more or less 24/7 that I didn't have to do at one time thanks to my COPD. If I get a bit slack on my forcing full exhalations, I can tell there's an elevated CO2 issue by how I feel.

[Ursego]

Hi guys,
I am not sure this article is right. But it is definitely interesting in the context of this topic:

https://www.sleepreviewmag.com/sleep-tre...ronavirus/

(I tried to insert a clickable link and got this: "I'm sorry, brand new members are not allowed to post links in this forum until they have 4 posts", so please copy-paste it into your browser).

Moderator action: link fixed.

[srlevine1]

Hi guys,
I am not sure this article is right. But it is definitely interesting in the context of this topic:

https://www.sleepreviewmag.com/sleep-tre...ronavirus/

(I tried to insert a clickable link and got this: "I'm sorry, brand new members are not allowed to post links in this forum until they have 4 posts", so please copy-paste it into your browser).

Moderator action:  link fixed.

URSEGO -- Thanks for the link.

It appears that you do not need to insert a clickable link -- just using the full address will turn into a link when you post.

Additionally, it appears that Dr. Winter takes much of his information from the AASM (American Academy of Sleep Medicine) which he links to on his professional page. There are a number of topics addressed.

Should patients with COVID-19, or suspected of having COVID-19, use CPAP at home?

If a patient is suspected or confirmed to have COVID-19, we suggest assessing  risks and benefits of continuing to use a PAP (CPAP/BPAP) device at home.  

Considerations include:

WHAT ARE THE RISKS OF CONTINUING PAP THERAPY? 
 
There may be increased risk of transmission of COVID-19 to others in the environment if PAP is continued. 
Consider individuals residing  in proximity to the patient, especially if they are at risk for severe infection. Dispersion of the virus with PAP is theoretically greater with than without PAP, but how much the risk to others changes specifically because of PAP therapy is not known. 
Viral particles may persist for some time depending on the type of surface.
Persons at risk for infection from using PAP include co-habitants of the same dwelling. 

Additionally, whether it is possible for the patient to be re-infected from tubing, filters, and/or mask reuse is not known.   

WHAT ARE THE RISKS OF DISCONTINUING PAP THERAPY?

OSA is a chronic disorder, and the risk of stopping PAP for a limited period of time until the patient is no longer contagious may be manageable, depending on the severity of the disorder and symptoms. Without PAP, however, some patients may experience an increase in health risks in the short term, such as accidents, safety incidents, falls, or cardiovascular events.

If such acute risks are identified, risk-mitigation strategies may be appropriate,  such as advising the patient to stop driving, adhere to fall precautions, and consult with their treating physician to optimize medical management of background medical conditions.
Using positional therapy or an oral appliance (if the patient already has one), limiting the use of alcohol and sedating medications, and addressing nasal congestion may also be effective for some patients.

If these short-term risk mitigation strategies are insufficient, and a decision is made to continue PAP in a patient who has confirmed COVID-19, or is suspected of having COVID-19, the patient should be advised to maintain strict quarantine and consider strategies for protecting household contacts.
The decision of whether to continue or stop PAP therapy should be based on whether the risk:benefit assessment favors continued therapy.

Other topics of interest on include:

Why could using CPAP increase the risk of spreading the virus to others?
Distilled water is unavailable in my area. What should my patient use in a CPAP humidifier? 
Is enhanced cleaning/disinfection of CPAP, HSAT and PSG equipment needed in response to COVID-19? Is soap and water enough to disinfect a CPAP mask?
The site (https://aasm.org/covid-19-resources/covid-19-faq) appears to be continually updated.

[Mer Ri Ly]

Seems to me this article fits right in to this topic.
Mon March 30, 2020. "London (CNN Business) Formula One engine manufacturer Mercedes has teamed up with clinicians and university engineers in London to design a breathing aid for coronavirus patients that can be quickly mass produced, a development that could help reduce the need for ventilators. The Continuous Positive Airway Pressure (CPAP) device, which was re-engineered from an existing machine in fewer than 100 hours, has been recommended for use by the UK Medicines and Healthcare products Regulatory Agency, according to a statement from University College London (UCL), which worked on the project."
CPAP devices have been used in hospitals in China and Italy to treat coronavirus infections, with reports indicating that roughly half of such patients have avoided the need for ventilators, according to the statement. There is a severe shortage of ventilators in many countries, including Britain, that are fighting severe outbreaks.

"These devices will help to save lives by ensuring that ventilators, a limited resource, are used only for the most severely ill," said professor Mervyn Singer, a critical care consultant at University College London Hospitals (UCLH).
CPAP machines help to keep patients' airways open and increase the amount of oxygen entering the lungs by pushing air and oxygen into the mouth and nose at a continuous rate. According to the statement, 100 of the newly-designed machines will be used in clinical trials at UCLH, with "rapid rollout to hospitals around the country ahead of the predicted surge in Covid-19 hospital admissions."
Professor Tim Baker of UCL said a process that can take years had been reduced to a matter of days, explaining that the team had worked "all hours" to disassemble and analyze an existing device before using computer simulations to "create a state-of-the-art version suited to mass production."
Following clinical trials, Mercedes and other F1 teams could produce up to 1,000 of the devices per day.
Some experts have raised concerns that using CPAP machines may put hospital workers at risk by creating a mist of droplets containing the virus. But Britain's National Health Service has recommended the devices be used to treat coronavirus patients, saying the risk of infection is low so long as staff wear personal protective equipment.

Andy Cowell, managing director of Mercedes-AMG High Performance Powertrains, said he was proud that the F1 engine maker was able to participate and help deliver the device on the "fastest possible timeframe."

The entire article is found at CNN.

[Cpapian]

On a slightly different tangent...

If I, or if someone in our family, have to be a caregiver, I would like to be able to wear some sort of protective covering.  I have wetsuits in the garage, and can use a lightweight (1mm) hood, but I really don't want to go the Navy seal route.  I was thinking of a vinyl or ripstop poncho.  Something easy to put on and take off, can be easily hosed off, and still have some use when this is all over.

Any thoughts?

John

We bought ellcheapo raingear from the dollar store.  They had two kinds, one slightly more sturdy.  So we bought both types.

If you don't end up using them, they are great to bring along on a vacation.  If you will ever dare do that again.

[FJD]

Hi everybody
Illinois give the world a new vent machine...

https://techxplore.com/news/2020-03-team...-vent.html

In My opinion, in matter to reduce the CO2 in the pipe, this valve shall be a close to the mask as possible... this is a nice try, but maybe improvement should be done.
As the disease reduce lung capacity, I don't trust this device...
As you can see on the chart, the 02 pressure goes to 30cm ... This is really a lot (and apparently not a drama). To put our CPAP on MAX level then reduce power to 95% saturation is certainly a good process.
Maybe should we start with 50% of the max power, and adjust (this dichotomic process is the fastest way but need to write pressure on a paper in the way to avoid forgetting the previous levels tested...
 
 
Best regards.
François-Joseph.

[mper6794]

........ If used for just one person, would the bilevel mode be preferable for Covid treatment? There seems to be disagreement about that. Finally, do you think a humidifier is helpful in this situation?

Hi, Dougo

_ Just to refresh: what we are discussing here would be as extreme case, when (1) hospital's risks would be higher than stay isolated at home, either in tent in the backyard or other alternatives to avoid aerolisation of virus; (2) you don't want to be intubated whatever the situation; (3) you are courageous enough to try not die in peace at home, while meditating, listening  reggae music, and tapping;

_ that is still a question: CPAP mode or BiPAP? I am still struggling to learn and decide on this....It is amazing how little we can get on this point (people look still concerned about aerolisation)!!!.... From all I have read (including Resmed issues) and thinking thus far, I am tending to Bilevel. It looks easier to contol TV (lower, maybe) and gas exchanges with the Bilevel. Of course, whatever CPAP or Bilvel would work only for mild pneumonia, it looks. Once lungs are flooded, only intubation would work, from what I have learned so far.

good luck

[Dougo]

Yes, only if you can't get into a hospital.  For TV (Tidal Volume), in an earlier post, a low tidal volume is recommended, along with a higher breathing rate.  Does one just keep the IPAP and EPAP relatively close to one another?

[3rdMarDiv]

With my last exposure with pneumonia I was given the following device as a PEP tool. This product is made in in Canada.

The Aerobika® OPEP device is a hand held device that uses Oscillating Positive Expiratory Pressure or OPEP to help clear secretions from your airways. People who have chronic bronchitis, bronchiectasis, COPD and cystic fibrosis often produce an excessive amount of mucus.
As you exhale through the Aerobika® OPEP device, you will feel vibrations or “pulses” that are loosening the mucus from the walls of your lungs, making it easier for you to cough up the secretions. There is a valve inside the Aerobika® OPEP device that switches quickly between higher and lower resistance creating positive pressure inside your airways. The degree of resistance can be changed depending on your comfort level.
Positive pressure will hold the airways open. Think of how you feel when you blow up a balloon. It is the positive pressure that holds the balloon open. Inside your lungs, the positive pressure opens up small airways that may be blocked by mucus.

Information Only Site
https://www.monaghanmed.com/Aerobika-OPEP

This product is sturdy and well made. It will cost more than Acapella. Prices for the basic unit will be $100+.

PS: Hope I am within website posting rules as I did not see any sales capability on this site. Looks to be medical information about this product.

 Snagged a new one from a reputable company on eBay for $76.64 with tax and free shipping. 

One of my instructors told me it is always better to have something and not need it than to need it and not have it. He seemed to get a little annoyed when I asked how much a man-portable tactical nuclear device weighed.

Great..! I'm sure you will see a big quality increase from the Acapella. The Aerobika is primarily marketed to hospitals. Plus, if the Acapella is sold on Amazon I would imagine it's made in China..? Maybe it's just me, but buying from the culprit just doesn't seem right.

I have a feeling that we all are going to be in this for the long run and as time goes on the chances of exposure will go up. Having the best quality defensive equipment is a goal for me.


Hopefully, I'm wrong about this. Maybe someone who has bought the Acapella could educate me on where it is manufactured?

Also, if you would be considered "High Risk" the your Doctor may agree that a prescription is in order for you to have a potential life saving device available.