Personal CPAP Machines in PACU of Uncertain Benefit

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
49er
Posts: 5624
Joined: Mon Jan 16, 2012 8:18 am

Personal CPAP Machines in PACU of Uncertain Benefit

Post by 49er » Sat Feb 28, 2015 4:41 am

In light of my recent experience to make sure my bipap is used in the recovery room after my septoplasty, I thought you all might find this article interesting.

http://respiratory-care-sleep-medicine. ... nefit.aspx
However, CPAP devices can be used only for patients who are arousable, cooperative and able to maintain their protective airway reflexes, Manohar said. "If there is an acute event where the patient is unstable, then you may need more invasive measures like intubation," she said. "But usually if the patient is arousable, we can wake them up and encourage deep breathing with supplemental oxygen. Then their oxygen saturation levels return to their baseline."

Furthermore, she said, the use of personal CPAP machines in the PACU requires additional hospital resources. Not only does each machine require staff time for processing and inspection, but the variety of machines available presents its own challenge. "Our technicians cannot be educated on how to use all these different machines," Dr. Manohar explained.

Contamination is another concern, either from CPAP machine to hospital patients and staff, or from hospital-acquired microbes coming home with patients on their machines after surgery. "One study found that patients with OSA who are treated with CPAP have an increased risk for upper airway infections compared with sleep apnea patients who receive conservative treatment," Manohar said (Respiration 2001;68:483-487).

To address the rare but real possibility of OSA patients needing CPAP in the PACU, Manohar suggested the use of standardized hospital-based machines in conjunction with patients bringing their personal CPAP masks.
Regarding patients being arousable, I am not sure what their point is since according to the research I have done, sleep apnea patients are not extubated until they are fully awake. And once again, they are feeding the myth that oxygen is the answer when if the patient can't breath, it is useless.

And the convenience issue once again has popped up. Regarding being educated on learning different machines, wtf? You mean folks with a medical background who have to learn how to operate various other hospital machine can't be bothered to do this?

Regarding cpap patients receiving infections, hmm, I would love to see the data on this. The cynical part of my brain says they are using this as an excuse because if this is really a factor, they can figure out how to solve the problem if they really cared.

By the way, I was told by the pre surgical admitting nurse to just bring my mask as the hospital would supply a machine. But because the anesthesiologist told me to bring my machine, obviously, I have to get this clarified as I definitely vote for my own device.

Anyway, I find this very discouraging since a place like Johns Hopkins is advocating this.

User avatar
Krelvin
Posts: 1977
Joined: Tue Jun 06, 2006 5:23 pm
Location: Metro Phx Area - Dry Heat!

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by Krelvin » Sat Feb 28, 2015 4:56 am

I have had several procedures over the years where I brought my machine with me. Normally it was used in the "room" when I got out of ICU. While in ICU if I was in one, they provided a BiLevel with mask as lying down on my back is hard for me to breath.

Never really had any problems. I think this might be a hospital vs hospital thing.
Current Settings PS 4.0 over 10.6-18.0 (cmH2O) - Resmed S9 VPAP Auto w/h5i Humidifier - Quattro Air FFM
TNET Sleep Resource Pages - CPAP Machine Database
Put your equip in your Signature - SleepyHead v1.0.0-beta-1
Kevin... alias Krelvin

User avatar
Morbius
Posts: 1040
Joined: Wed Jan 28, 2015 7:03 pm

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by Morbius » Sat Feb 28, 2015 5:13 am

49er wrote:Anyway, I find this very discouraging since a place like Johns Hopkins is advocating this.
Maybe they think the 10 million dollar cardiopulmonary monitoring system is enough to keep you out of trouble...

User avatar
Morbius
Posts: 1040
Joined: Wed Jan 28, 2015 7:03 pm

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by Morbius » Sat Feb 28, 2015 5:17 am

..and after Josie King, if you think JH is about to let ANY slip-up happen without trying everything under the sun to make sure it don't, then I would find THAT very discouraging.

User avatar
49er
Posts: 5624
Joined: Mon Jan 16, 2012 8:18 am

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by 49er » Sat Feb 28, 2015 5:34 am

Krelvin - I am glad you didn't have any problems with using your pap machine in the hospital. In my situation, it is a good sign that the anesthesiologist seemed to understand the importance of having it on immediately soon as I am extubated. But of course, I am taking nothing for granted due to this being an obviously high stakes issues.

Morbius -
Maybe they think the 10 million dollar cardiopulmonary monitoring system is enough to keep you out of trouble...
- Thanks for a good laugh even though it really isn't funny. You nailed things precisely.

Wow, I was not familiar with the Josie King situation. OMG! I just skimmed the article that I found on it but this reminded me of another situation in which a teenager went for surgery at a very reputable place and died because doctors didn't recognize early enough that he was suffering an adverse reaction to a pain med. The parents kept expressing concern but were blown off.

However, at the same time, I personally know of a few situations where there was horrible care at other hospitals and it was JH that provided the answers. So who knows?

49er

User avatar
LSAT
Posts: 13229
Joined: Sun Nov 16, 2008 10:11 am
Location: SE Wisconsin

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by LSAT » Sat Feb 28, 2015 8:54 am

When I had my septoplasty my doctor recommended not using CPAP in recovery for fear that it would prevent blood from clotting or would break clots loose. There was an anesthesiologist present during the surgery and recovery was only about 30 minutes. He recommended that I not use CPAP for 5 days. I slept in a recliner for 3 nights and then went back to CPAP, but at a slightly lower pressure for a couple days. Different doctors use different procedures. I had no packing in my nose after surgery.
.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion)
Additional Comments: Back up is S9 Autoset...... Buckwheat hull pillow

User avatar
Jay Aitchsee
Posts: 2936
Joined: Sun May 22, 2011 12:47 pm
Location: Southwest Florida

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by Jay Aitchsee » Sat Feb 28, 2015 9:39 am

Of course, there's always this to consider: Hospital Errors are the Third Leading Cause of Death in U.S.

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Auto, P10 mask, P=7.0, EPR3, ResScan 5.3, SleepyHead V1.B2, Windows 10, ZEO, CMS50F, Infrared Video

User avatar
Morbius
Posts: 1040
Joined: Wed Jan 28, 2015 7:03 pm

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by Morbius » Sat Feb 28, 2015 11:25 am

Jay Aitchsee wrote:Of course, there's always this to consider: Hospital Errors are the Third Leading Cause of Death in U.S.
That's odd.

I thought cancer success rates were improving enough...

Well, NM.

Anyway, the current federal plan to improve health care (centralization) will take decades to work-- cut reimbursements, forcing a small percentage of unstable hospitals to close, thus allowing other hospitals to gain from those closures for a few years until the next round...

..meanwhile, the best and the brightest pursue better paying careers in finance, law, management, etc., so the health care skill set continues to decline. Then the next level of hospitals close after a few years, and the process slowly repeats.

And everybody says "Wow that's terrible!!" but nothing can be done about it.

After a few cycles it will get better, but certainly not in your lifetime (however long that is-- see above).

User avatar
archangle
Posts: 9294
Joined: Sun Mar 27, 2011 11:55 am

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by archangle » Sat Feb 28, 2015 1:59 pm

Sounds like someone trying to protect their job and generate revenue.

"It takes hospital resources."

"Our technicians cannot be educated on how to use all these different machines," You mean, teach them where the on/off button is, and to check the exhale vent to see that the machine is blowing air? Your staff isn't going to be adjusting the CPAP pressure and settings. Maybe you should just have a bunch of red arrow stickers that you stick on the on-off button for CPAP machines and teach the staff how to feel the airflow coming out of the CPAP mask.

Do you realize the amount of time and effort it's going to take to find the correct pressure settings, and get a qualified person to set up the "standard hospital based machine" to the correct settings for the individual patient? Do you realize that CPAP is not just a simple, standard machine you hook up and forget? How many patients are you going to harm because you didn't get the right settings? Once you set up your hospital-based CPAP machine, aren't you going to have a respiratory therapist do the mask fitting and check that the machine is working correctly? Don't forget that you're going to have to disinfect the hospital-based CPAP equipment before you use it on the next patient.

Can anyone be this stupid? If you've ever worked with CPAP patient, you would know that it often takes a long time and many attempts to find a mask that works, and that the patient can tolerate. Even if you find the right mask, there is often a lot of tinkering to adjust the headgear correctly. You're going to spend a lot of time getting the adjustment right for the patient and then monitoring the patient and adjusting when there are leaks or other problems. Not really. You're just going to slap a mask on the patient and ignore any problems that occur. Or maybe put on a full face mask and tighten it down so tight to stop leaks that you cut off blood flow to the patient's scalp. Even with the "correct" settings, there's often a lot of tinkering needed to get the CPAP machine set right.

"staff time for processing and inspection". Inspection? You mean checking that the power cord isn't frayed and looking for the UL or other certification on the power brick? Do you really think that's going to take more effort than disinfecting a "hospital based machine," configuring it to the patient's needs, fitting a mask, trying it on, etc.?

"Contamination is another concern ... from hospital-acquired microbes coming home with patients on their machines after surgery." If your hospital has a risk of MRSA and other infections, isn't it likely that you'll infect the patient directly from the "standard hospital based machine" while he's in the hospital? If you're going to contaminate the patient's CPAP, aren't you going to contaminate the hospital-based CPAP machine? Or simply infect the patient directly instead of from your hospital contaminating his CPAP machine? If you're worried about "infecting" the non-porous, plastic CPAP machine, and then having that machine infect the patient later, you're probably a dozen times more likely to infect the patient while he's in your hospital.

However, it is probably a good idea to recommend a good cleaning of the mask and hose after the patient goes home,

"But usually if the patient is arousable, we can wake them up and encourage deep breathing with supplemental oxygen. Then their oxygen saturation levels return to their baseline." You mean, instead of CPAP, you're going to keep the patient awake?

So instead of being able to nap in the recovery room, you're going to 1) let the oxygen monitor go off, 2) wait for the nurse to notice and come in, 3) Wake the patient up and tell them to breathe. You realize that the instant the patient goes back to sleep, he's going to have another apnea. You also realize that many untreated apneacs have events 30 times an hour or so, don't you? Do you also realize that supplemental O2 doesn't help many apneac because they're not breathing? So basically, you're planning to keep the patient awake the whole time, and tie up a nurse to keep him awake and telling him to breathe. I watched them do this to my Dad in the recovery room. Basically, a nurse sat there and wouldn't let him sleep.

Tell me again how it's going to be more expensive to inspect and handle the patient's CPAP machine than it is to have the nurse waking the patient up every time he dozes off.

"Contamination is another concern, either from CPAP machine to hospital patients and staff" Gee, don't you think the patient is a lot more likely to contaminate your hospital patients and staff? If some bug is on the CPAP machine, it's probably already on the patient as well. Doesn't your staff decontaminate after handling a patient or medical equipment attached to the patient? Don't forget that CPAP machines are mostly non-porous plastic. If you're spreading infections around from the patient's CPAP, you're going to spread it around from the hospital-based CPAP machine once it's been contaminated by being used on a patient.

"If there is an acute event where the patient is unstable, then you may need more invasive measures like intubation,"

So if the patient needs to be intubated, you can't use CPAP as a substitute. I'm SHOCKED, SHOCKED to hear that a CPAP isn't a substitute for being intubated. Or did you think that you could use a CPAP machine on an intubated patient? Don't most of your patients hang around and sleep for a while after your remove the breathing tube?

_________________
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Also SleepyHead, PRS1 Auto, Respironics Auto M series, Legacy Auto, and Legacy Plus
Please enter your equipment in your profile so we can help you.
Click here for information on the most common alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check for yourself.

Useful Links.

User avatar
BlackSpinner
Posts: 9745
Joined: Sat Apr 25, 2009 5:44 pm
Location: Edmonton Alberta
Contact:

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by BlackSpinner » Sat Feb 28, 2015 3:17 pm

Yes would have a lot of trouble with the concept that ICU staff can not be taught how to put on a mask and to push the ON button. I don't think they should be working there then. Maybe they could go and push a broom somewhere else.

_________________
Machine: PR System One REMStar 60 Series Auto CPAP Machine
Mask: Hybrid Full Face CPAP Mask with Nasal Pillows and Headgear
Additional Comments: Quatro mask for colds & flus S8 elite for back up
71. The lame can ride on horseback, the one-handed drive cattle. The deaf, fight and be useful. To be blind is better than to be burnt on the pyre. No one gets good from a corpse. The Havamal

User avatar
kteague
Posts: 7768
Joined: Tue May 16, 2006 8:30 pm
Location: West and Midwest

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by kteague » Sat Feb 28, 2015 4:10 pm

Just thinking another layer to the hospitals' preference to not accommodate or supply CPAP when they can avoid it is liability. Once that nurse slaps on a mask and hits the ON button, that puzzle piece becomes a player in any lawsuit. And I can just imagine if hospitals wholly trust patients to accurately relay their prescribed treatment it could be chaos. Should the hospital require orders from the doctor prescribing the treatment? Anyone who is self treating would be out of luck. What if the machine data shows the treatment wasn't effective in that current situation, like high leaks or high AHI due to sedation? Or the oxygen monitor keeps going off in spite of using CPAP? Who handles that? How many doctors are going to risk liability to order a treatment they didn't prescribed? I certainly understand the overall reluctance of hospitals, but the issue does need addressed. I for one refuse to go without my machine. I just don't think the issues are as simple as they should just let me use it. I am one of many and all cases wouldn't be as easily managed. Guess my years working in health care have me trying to see that side.

_________________
Mask: TAP PAP Nasal Pillow CPAP Mask with Improved Stability Mouthpiece
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Bleep/DreamPort for full nights, Tap Pap for shorter sessions

User avatar
Morbius
Posts: 1040
Joined: Wed Jan 28, 2015 7:03 pm

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by Morbius » Sun Mar 01, 2015 4:41 am

BlackSpinner wrote:Yes would have a lot of trouble with the concept that ICU staff can not be taught how to put on a mask and to push the ON button. I don't think they should be working there then. Maybe they could go and push a broom somewhere else.
The above article (based on a supplement that no longer exists) relates to PACU, not ICU, where the ALOS is 1- 2 hours.

The position of SAMBA is that OSA is of great concern (see position expressed by Frances Chung).

User avatar
Morbius
Posts: 1040
Joined: Wed Jan 28, 2015 7:03 pm

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by Morbius » Sun Mar 01, 2015 4:43 am

kteague wrote:Just thinking another layer to the hospitals' preference to not accommodate or supply CPAP when they can avoid it is liability.
It's only JH PACU that is thinking about this. Everybody knows that

http://journals.lww.com/anesthesia-anal ... ith.4.aspx

User avatar
Morbius
Posts: 1040
Joined: Wed Jan 28, 2015 7:03 pm

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by Morbius » Sun Mar 01, 2015 4:53 am

archangle wrote:Tell me again how it's going to be more expensive to inspect and handle the patient's CPAP machine than it is to have the nurse waking the patient up every time he dozes off.
Very expensive. See above 10 million dollar monitoring system.

Further, OSA is frequently positional, and the one position nobody talks about around here is upright (for obvious reasons)(or maybe not). Consequently, the recommendation is to place patient in a semi-upright position (because they are, in fact, not there to sleep, they are there to wake up):

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

User avatar
49er
Posts: 5624
Joined: Mon Jan 16, 2012 8:18 am

Re: Personal CPAP Machines in PACU of Uncertain Benefit

Post by 49er » Sun Mar 01, 2015 5:09 am

Morbius wrote:
archangle wrote:Tell me again how it's going to be more expensive to inspect and handle the patient's CPAP machine than it is to have the nurse waking the patient up every time he dozes off.
Very expensive. See above 10 million dollar monitoring system.

Further, OSA is frequently positional, and the one position nobody talks about around here is upright (for obvious reasons)(or maybe not). Consequently, the recommendation is to place patient in a semi-upright position (because they are, in fact, not there to sleep, they are there to wake up):

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

I was going to ask my ENT and anesthesiologist about being placed in a semi-upright position but when I took a 20 minute nap with the Full Face Fit Life mask using a wedge pillow, I had a 33 AHI although I think half were false centrals. Maybe the key is I need to be upright more? I will take a look at the link you provided that I thank you for.