Personal CPAP Machines in PACU of Uncertain Benefit

[49er]

In a PACU and there are many activities going on in the short amount of time a patient is there. The reason for a PACU is to monitor a patient until they are recovered from anesthesia (this means frequent awakings) and to be able to maintain their airway on their own. Unless it is contraindicated, the head of the bed will be elevated so you don't have to worry about a wedge pillow in an adjustable bed. I was always within a few feet from my patient's (no more than 2 at a time) where I could see and hear everything going on. Usually you are in the PACU from less than an hour to one and a half hours unless they are having a bed shortage but that's a different discussion. http://www.ncbi.nlm.nih.gov/pubmed/9728843
As far as the training of staff on machines, you have to take into consideration the number of different brands and types of machines if every patient brought their own. The hospitals would probably pick one machine to train staff on and let the patient bring their mask.
From my perspective, and I've been a patient also, I don't see the benefit of CPAP in PACU,for most patients, since we don't want you to sleep for long periods in the limited amount of time you are in the PACU.
Now when you are in a room, ICU or regular floor, where you are going to be sleeping for longer periods, by all means your CPAP machine is appropiate.

Oky Doky,

But what if the patient does nod off? Do you seriously want patients with with sleep apnea blowing off anesthesia gases sleeping without the machine?

And what if you are called away to assist in an emergency? Then what? I remember a patient with sleep apnea died because of a similar type situation.

Hmm, and using the hospital machine also adds considerably to the hospital bill. And of course, let's not forget about patient comfort since most hospital machines are not up to date.

Thankfully, an anesthesiologist told me to bring my own machine and was quite adamant after I was told differently. But it is one more hassle for me to deal with in reconciling this issue.

Regarding the staff being able to use different machines, hmm, if there is a willingness to learn, there is a solution to the problem such as having the patient come in before the surgery to do a training session.

Anyway, thanks for sharing your perspective.

[49er]

In a PACU and there are many activities going on in the short amount of time a patient is there. The reason for a PACU is to monitor a patient until they are recovered from anesthesia (this means frequent awakings) and to be able to maintain their airway on their own. Unless it is contraindicated, the head of the bed will be elevated so you don't have to worry about a wedge pillow in an adjustable bed. I was always within a few feet from my patient's (no more than 2 at a time) where I could see and hear everything going on. Usually you are in the PACU from less than an hour to one and a half hours unless they are having a bed shortage but that's a different discussion. http://www.ncbi.nlm.nih.gov/pubmed/9728843
As far as the training of staff on machines, you have to take into consideration the number of different brands and types of machines if every patient brought their own. The hospitals would probably pick one machine to train staff on and let the patient bring their mask.
From my perspective, and I've been a patient also, I don't see the benefit of CPAP in PACU,for most patients, since we don't want you to sleep for long periods in the limited amount of time you are in the PACU.
Now when you are in a room, ICU or regular floor, where you are going to be sleeping for longer periods, by all means your CPAP machine is appropiate.

I understand the purpose of the PACU is to wake patients up but to achieve that takes time. Even after you have opened your eyes you can drift off to sleep again. I can tell you that as soon as my eyes closed I stopped breathing. Having a nurse right there shaking me awake will not diminish the horrible feeling of suffocation.

Exactly Webbie and that is another reason I have fought so hard to make sure my machine is used in recovery. But because of posts like Oky Doky's I still greatly fear this will fall through the cracks and I shouldn't be having to worry about this.

I know Oky Doky means well but I am beginning to think this is an issue of convenience vs. patient well being and comfort. I find that very unsettling.

[Morbius]

I have done massage on people ...

Thank you for your comments, but unfortunately, that does not qualify you to assess these complex medical conditions.

[OkyDoky]

I understand the purpose of the PACU is to wake patients up but to achieve that takes time. Even after you have opened your eyes you can drift off to sleep again. I can tell you that as soon as my eyes closed I stopped breathing. Having a nurse right there shaking me awake will not diminish the horrible feeling of suffocation.

Exactly Webbie and that is another reason I have fought so hard to make sure my machine is used in recovery. But because of posts like Oky Doky's I still greatly fear this will fall through the cracks and I shouldn't be having to worry about this.

I know Oky Doky means well but I am beginning to think this is an issue of convenience vs. patient well being and comfort. I find that very unsettling.

Everyone has their own personal perspective and I'm not trying to take away from yours. Just add something to think about. Webbie it is possible your feelings of suffication and not breathing were lingering effects of the anesthesia which causes respiratory depression and in that case pressure would not change that only time.

[49er]

Unless it is contraindicated, the head of the bed will be elevated so you don't have to worry about a wedge pillow in an adjustable bed.

How do you know if it is contraindicated or not?

Thanks!

49er

[Morbius]

Morbius, please explain...

Let's start with

http://www.asahq.org/~/media/Sites/ASAH ... logist.pdf

to see the different levels sedation/anesthesia.

Then use the ToolKit:

http://www.aaahc.org/Documents/Institut ... %20pdf.pdf

As previously noted, the addition of supplemental oxygen can mask desaturating obstructive sleep apnea (it can also make it worse, but let's hold on that a bit). Hefty preoxygenation can keep somebody fine ~8 minutes:

http://rebelem.com/preoxygenation-apneic-oxygenation/

However, the hidden danger of extended apnea is rising pCO2 and dropping pH (which can generate catastrophic arrhythmia).

Consequently, the BEST answer is to monitor ETCO2 in high risk patients (see algorithm) when indicated.

[Morbius]

Unless it is contraindicated, the head of the bed will be elevated so you don't have to worry about a wedge pillow in an adjustable bed.

How do you know if it is contraindicated or not?

Abdominal surgery with vacuum dressing; severe obesity; hemodynamic instability; pregnancy; spinal (thoracic/lumbar/sacral) surgery or trauma; trauma of the pelvic region; severe sacral decubitus...

[chunkyfrog]

Just wondering, who is this Morbius, really?
The attitude and language sounds awfully familiar . . .

[Morbius]

...LP...

[OkyDoky]

Unless it is contraindicated, the head of the bed will be elevated so you don't have to worry about a wedge pillow in an adjustable bed.

How do you know if it is contraindicated or not?

Abdominal surgery with vacuum dressing; severe obesity; hemodynamic instability; pregnancy; spinal (thoracic/lumbar/sacral) surgery or trauma; trauma of the pelvic region; severe sacral decubitus...

Thanks for answering this while I was away.

[49er]

Unless it is contraindicated, the head of the bed will be elevated so you don't have to worry about a wedge pillow in an adjustable bed.

How do you know if it is contraindicated or not?

Abdominal surgery with vacuum dressing; severe obesity; hemodynamic instability; pregnancy; spinal (thoracic/lumbar/sacral) surgery or trauma; trauma of the pelvic region; severe sacral decubitus...

Sorry, I wasn't clear again. Since many people like BS have just as bad apneas in an upright position, how do they determine what position is best?

In my own situation, I suspect I would be do better in a semi upright position but at the same time, because my AHI seems worse using a wedge pillow, I am not sure. Do they just put everyone in that position as a protocol if you have sleep apnea?

By the way, I know this is a question I need to ask of my medical team but I was just curious.

Thanks!

[palerider]

I don't have a horse in this race, but it sure is interesting and entertaining.

[Morbius]

Since many people like BS have just as bad apneas in an upright position...

This is an undocumented assumption, but I shall let OD respond as I had inadvertently and rudely interfered with her response above.

[chunkyfrog]

Once again we see the most disturbing medical attitude of all beginning to infect the laity.
This is the attitude that one size fits all, therefore what fits Peter will fit Paul.
Lazy medicine, because we are all different, and divergence is a crime, punishable by death.

[49er]

Since many people like BS have just as bad apneas in an upright position...

This is an undocumented assumption, but I shall let OD respond as I had inadvertently and rudely interfered with her response above.

Perhaps but is it documented somewhere that most people with sleep apnea do better in a semi upright position?

Thanks!