CPAP use for Coronavirus mitigation & severe pneumonia

[JohnAP]

Gov Cuomo provided more information on 4/2/20 about his plans for using BiPap for ventilation:

Moderator note: The Northwell Health initiative is to use a "BiPAP" machine for invasive ventilation. This requires the patient to be intubated. This is NOT a DIY solution.

[Maggie]

Good point on checking a user's post counts Maggie. Best wishes you ride out the storm with the rest of AB in relative sanity.

Thank you, Dave and of course I wish the same for you and yours - and all members and all of their families too!

 Here's a suggestion that might interest older members. who have time on their hands or shut-ins, ditto!  

As I can't do much else useful for the overall community at the moment, I'm checking a few more pages of this Forum every day and cutting and pasting into an email the pages and post #s that seem to me most useful.  I then send the emails to my sons and they file them.   If/when the time comes that anyone in our close circle needs the use of my CPAP machine (or my old one)  to fight the virus, these emails can be used as a fast track through this amazing Forum for my son to convert the CPAPs into a linked pair, or separately as a ventilator that can be vented through liquid or into a paper bag or whatever.  I'm not pretending I understand every word of every post but my son assures me that he will use the emails to get himself up to speed. should the need arise.  Once I catch up, I'll be able to just check the previous day's page and stay abreast of everything everyone posts.

Keep up the good work, all you *PAPpers!

[SarcasticDave94]

[geauxdbl]

Gov Cuomo provided more information on 4/2/20 about his plans for using BiPap for ventilation:

This is a positive improvement, but we need to address a common misconception involving the word "BiPap"

https://feinstein.northwell.edu/news/the...ed-adapter

The bipap machines they're using are the hospital-grade Philips V60 capable of backup rate, connected to a closed loop ventilator tube stuck in the throat of an unconscious person.  It's a great thing, and it will help save the lives of a lot of people, but it bears as much similarity to our consumer bilevel machines as a monster truck does to a Ford F-150.

But if we do what we can with what we have, we might be able to keep symptoms in the "mild to moderate" range and avoid needing to go into a hospital.  Using our CPAP and Bilevel machines 24/7 at home to keep the alveoli open and utilizing postural drainage looks like the best way to do that.

I'm still unsure of what the minimum effective pressure is, but maybe it varies.

Moderator note: The Northwell Health initiative is to use a "BiPAP" machine for invasive ventilation. This requires the patient to be intubated. This is NOT a DIY solution.

[raisedfist]

Gov Cuomo provided more information on 4/2/20 about his plans for using BiPap for ventilation:

The V60 is a popular non-invasive ventilator used in hospitals, and can quite easily be converted for invasive mechanical ventilation with an adapter and a hepa filter

[Johnboy]

More on the home made mask solution ie using some type of filter to allow us to effectively use a CPAP mask. I have attached a link that tested lots of different materials. As usual nothing ever simple. The most effective for filtering are also the hardest to breathe through. Surgical masks are best but of course we want to leave them for the health professionals.

https://smartairfilters.com/en/blog/best...ask-virus/

[SleepyTexasGirl]

I've been reading through this thread off and on over time. As an alternate thought to all of us volunteering our own or family members machines (2 of 3 of my family have mild apnea and the 3rd has his old machine) for respirators in case of an emergency, could a SoClean be used to disinfect used hospital N95 masks?

[Gideon]

I would say yes. Keep in mind that exposure to OZONE will degrade elastic and other components of this single-use mask. How many cycles can the mask withstand? I have no idea.

[srlevine1]

If they are willing to share the printer program and protocol, this would solve a lot of do-it-yourself issues. And apparently they are! 

Northwell Health Converts BiPAP Machines Into Ventilators

n preparation for potential patient surge and shortage of critical mechanical ventilators for hospitalized COVID-19 patients, a Northwell Health physician, a respiratory therapist, and a 3D printing bioengineer have successfully designed the protocol to turn the more common bilevel positive airway pressure (BiPAP) machine into a functional invasive mechanical ventilator, through a 3D printed adaptor they also designed to aid in the conversion.

As the health systems nationwide brace themselves for a potential increase in COVID-19 patients and New York Governor Andrew Cuomo calls for an increased supply of ventilators for hospitals statewide, a team led by Hugh Cassiere, MD, medical director for respiratory therapy services at North Shore University Hospital (NSUH) and Stanley John, NSUH’s director of respiratory therapy, developed a method to convert the non-invasive Philips Respironics V60 BiPAP machine into a pressure controlled ventilator for both patients with and without COVID-19 induced lung disease.

“Our hospitals are at the US epicenter of the coronavirus epidemic, and some of our COVID-19 patients require intensive care unit therapy and mechanical ventilators within minutes of being hospitalized,” says Cassiere in a release. One sleepless night, Cassiere thought of the fleet of unused BiPAP machines in the hospitals. “I knew we could develop a way to repurpose and convert these machines to save hundreds of lives.”

Currently, Northwell Health has an adequate supply of ventilators for its patients, and the health system is continually trying to obtain more ventilators to prepare for a likely surge. And while there are plans in place to handle a surge in patient volume, Northwell Health has a good supply of BiPAP machines across its 23 hospitals, and if faced with a surge when ventilators numbers do get low, it would be helpful to use these machines.

The key component to converting the BiPAP machine is a small, plastic T-piece adapter. Because of COVID-19 related supply change shortages, Cassiere and Stanley John collaborated with Northwell Health’s 3D Design and Innovation department, and together they designed and 3D printed a T-piece in a matter of days.

“We were able to imitate the design of the T-piece adapter and print the plastic-resin piece with our 3D printers,” says Todd Goldstein, PhD, director of 3D Design and Innovation at Northwell Health. “If the need arises, we would be able to print 150 adaptors inhttps://a360-sleepreviewmag.s3.us-west-2.amazonaws.com/wp-content/uploads/2020/03/BiPAP-conversion-3D-printed-adapter.mp4 24-hours.”

Cassiere, Goldstein, and Stanley John successfully tested the conversion of the BiPAP machine using the standard, non-3D printed adaptor for both COVID-19 and non-COVID-19 patients. They have also tested the 3D printed T-adaptor and have ramped up production to adopt the 3D printed adaptor clinically in the coming days.

Northwell’s partner, Formlabs Healthcare, is helping to print and host the 3D design files on its website.

In addition to the T-piece adaptor, modifications to the BiPAP machine include the addition of two high-efficiency particulate air (HEPA) filters at both ends of the oxygen hose to alleviate fears of spreading the virus. They are also recommending using a blind reservoir connected to the last HEPA filter in the circuit (see the video above; it is also available on Google Drive).

video link https://a360-sleepreviewmag.s3.us-west-2...dapter.mp4

Moderator note: The Northwell Health initiative is to use a "BiPAP" machine for invasive ventilation. This requires the patient to be intubated. This is NOT a DIY solution.

[Tubaman]

A wild thought just occurred to me: Has anybody considered the use of LiOH (Lithium Hydroxide) for CO2 removal from the (CPAP) face masks sans PAP?  That was the chemical used in the original Apollo back-pack life support systems back in the mid-1960s.  The respiratory system in the back-pack had a LiOH canister that the astronaut's air was cycled through (scrubbed?) to remove the CO2 and then add O2 and reuse the air since there was no air available on the moon.

Just an 'off-the-wall' thought.  I think this thread is about 'brain-storming' -- no absurd ideas to be rejected or jeered (and this is probably absurd).  I worked on the Apollo back-pack project back in 1963 to 1966. I suspect the amount of LiOH required would be too much to be practical.  I have no idea about the availability of LiOH.

Carl