COVID 19 and non invasive ventilation support

[colomom]

In light of the recent COVID19 outbreak it appears that the FDA has authorized the use of CPAP, APAP, and bilevel machines to treat respiratory distress for patients requiring less invasive ventilation. In normal circumstances of course the answer to my question would be ask your doctor, but we are not in normal circumstances. So my question is: if the medical system becomes overwhelmed, does anyone know how we could possibly support respiratory issues at home that may arise with COVID 19 with CPAP, APAP, or bilevel machines to hopefully diminish chances of needing hospitalization?

https://www.fda.gov/medical-devices/let ... -providers
"The U.S. Food and Drug Administration (FDA) recognizes that the need for ventilators, ventilator accessories, and other respiratory devices may outpace the supply available to health care facilities during the Coronavirus Disease 2019 (COVID-19) outbreak....
On March 22, 2020, the FDA issued an immediately in effect guidance outlining a policy intended to help increase availability of ventilators and their accessories as well as other respiratory devices during the COVID-19 pandemic....
This Letter provides recommendations for health care providers and facilities, based on the recently issued guidance, regarding the use of devices with patients who develop respiratory compromise from COVID-19 or other respiratory disorders. The FDA's recommendations are intended to augment, not replace, specific controls and procedures developed by health care organizations and the Centers for Disease Control and Prevention (CDC). ..
If the number of ventilators in your facility is running low, consider alternative devices capable of delivering breaths or pressure support to satisfy medically necessary treatment practices for patients requiring such ventilatory support. Health care providers should use their judgment based on the condition of the patient and the circumstances in the facility to choose the best option. Examples of alternative uses of respiratory devices used to address shortages might include the following, which the FDA believes may help increase availability:...
Continuous Positive Airway Pressure (CPAP), auto-CPAP, and bilevel positive airway pressure (BiPAP or BPAP) machines typically used for treatment of sleep apnea (either in the home or facility setting) may be used to support patients with respiratory insufficiency provided appropriate monitoring (as available) and patient condition."

[LSAT]

You neglected to include the next paragraph where it indicated the potential danger of using the CPAP in these instances..

Ventilating patients with communicable diseases using devices that are single limb or noninvasive without a filtered seal from atmosphere may contaminate the room air and increase risk of transmission. This risk may be exacerbated by high-flow nasal cannula systems or CPAP machines.

[Pugsy]

Home treatment of an ill COVID 19 patient with cpap or whatever pap....very likely a very ill patient at that.
It's going to spray out the virus through the vent holes but the patient probably has spread it further than that just by coughing into the bedroom. The patient has likely contaminated the entire bedroom already so that part of it doesn't really alarm me any more than I would be alarmed going into the bedroom when the machine wasn't even in use.

If there was no room in the hospital at all for such a very ill patient....and cpap is considered to be needed at home ...most definitely bring a doctor in and let him/her offer advice on settings and all that stuff. Someone that ill should be somehow or other under a doctors care even if it is at home.

As comfortable as I am messing around with things there is no way that I would add cpap to a very ill patient without having a doctor advise me how to do it and what to look for and how to best mitigate the spray out the vent holes.
I wouldn't be so scared of the virus as I would be that I might cause harm to the patient. Now if a doctor told me it was safe and gave me a range of parameters to use as settings....I would do it in a heart beat. Using CPAP or whatever pap with exhale relief to the max would offer a little pressure support and it would make it easier for a person to breathe on their own (it will NOT force them to breathe though) and the extra humidity would likely also be a benefit.

This is one thing I would NOT be comfortable doing without at least talking to a doctor about it.
I just wouldn't do it...and if the person couldn't breathe on their own cpap isn't going to force them to breathe. It can't do it unless it's one of those high end models that can treat central apneas.

[colomom]

You neglected to include the next paragraph where it indicated the potential danger of using the CPAP in these instances..

Ventilating patients with communicable diseases using devices that are single limb or noninvasive without a filtered seal from atmosphere may contaminate the room air and increase risk of transmission. This risk may be exacerbated by high-flow nasal cannula systems or CPAP machines.

For those of us who use CPAP every night we are already potentially contaminating our bedroom air. Is your argument that in light of COVID19 we shouldn’t use our CPAP machines at all?

[jnk...]

You neglected to include the next paragraph where it indicated the potential danger of using the CPAP in these instances..

Ventilating patients with communicable diseases using devices that are single limb or noninvasive without a filtered seal from atmosphere may contaminate the room air and increase risk of transmission. This risk may be exacerbated by high-flow nasal cannula systems or CPAP machines.

For those of us who use CPAP every night we are already potentially contaminating our bedroom air. Is your argument that in light of COVID19 we shouldn’t use our CPAP machines at all?

If you have symptoms of a potentially deadly disease with a high likelihood of being easily transmitted by respiratory droplets/aerosal, take all needed precautions to protect the lives of others in the household, yes. Get medical advice on exactly how to accomplish that in your specific circumstance if you are confused on the details, as your question clearly indicates you are. And you may want to be careful not to confuse others in forums in the meantime.

[colomom]

Home treatment of an ill COVID 19 patient with cpap or whatever pap....very likely a very ill patient at that.
It's going to spray out the virus through the vent holes but the patient probably has spread it further than that just by coughing into the bedroom. The patient has likely contaminated the entire bedroom already so that part of it doesn't really alarm me any more than I would be alarmed going into the bedroom when the machine wasn't even in use.

If there was no room in the hospital at all for such a very ill patient....and cpap is considered to be needed at home ...most definitely bring a doctor in and let him/her offer advice on settings and all that stuff. Someone that ill should be somehow or other under a doctors care even if it is at home.

As comfortable as I am messing around with things there is no way that I would add cpap to a very ill patient without having a doctor advise me how to do it and what to look for and how to best mitigate the spray out the vent holes.
I wouldn't be so scared of the virus as I would be that I might cause harm to the patient. Now if a doctor told me it was safe and gave me a range of parameters to use as settings....I would do it in a heart beat. Using CPAP or whatever pap with exhale relief to the max would offer a little pressure support and it would make it easier for a person to breathe on their own (it will NOT force them to breathe though) and the extra humidity would likely also be a benefit.

This is one thing I would NOT be comfortable doing without at least talking to a doctor about it.
I just wouldn't do it...and if the person couldn't breathe on their own cpap isn't going to force them to breathe. It can't do it unless it's one of those high end models that can treat central apneas.

Good advise Pugsy.

I’ve always found the talk to your doc advice sounds great. Unfortunately in the real world docs are busy and don’t always have time to get back to you, the communication difficulties become even more difficult when they cancel your upcoming appointments until the foreseeable future because “in light of if the COVID19 outbreak we are canceling all inpatient appointments”.

Your advice is sound. Hopefully medical resources do not become so stretched that they are only available to those who are in serious distress.

[Pugsy]

Remember....regular cpap/apap/bilevel machines aren't going to actually ever function as a non invasive ventilator. People still have to be able to breathe on their own. If a person can't breathe on their own and need real ventilator functions to force a breath...cpap/apap isn't going to help much beyond maybe making it easier for them to breathe but they still must be able to breathe on their own.

The only machines that would actually work as a non invasive ventilator are the models that can treat central apnea and actually force a breath. Cpap/apap/regular bilevel simply can't force anything.

I don't know what to do about a doctor that won't return calls except fire his lazy ass....especially if he knew I was caring for a COVID 19 patient at home. I know finding a new doctor now....wouldn't be easy either. Damned if you do and damned if you don't but I can usually cause enough ruckus that someone will communicate with me when I set my mind to it.
That old squeaky wheel thing. And I can be very annoying when I squeak.

[palerider]

People on this "I'll use my cpap as a vent" should read, and try and understand this:
https://hackaday.com/2020/03/25/ventila ... they-work/

[klm49]

I can attest to the fact that an APAP can help someone having breathing difficulties. I have COPD and not on O2. When I an having a bad day breathing or am having an "exacerbation" I can gook up to my APAP and turn it on and get a little relief. While it is not the ideal solution it is better than doing nothing.

[thx1138]

CPAP Machines Were Seen As Ventilator Alternatives, But Could Spread COVID-19

https://www.npr.org/sections/health-sho ... d-covid-19

[chunkyfrog]

If a family member contracts the virus, it is almost certain that everyone in the house has as well.
Home use of a spare device might be recommended by a doctor,
since immediate spread has already breached the gate.

[thx1138]

Only patients under 60 are getting ventilators in Italy as hospitals are overwhelmed by coronavrius crisis

https://www.the-sun.com/news/576232/doc ... -shortage/

Think it couldn't happen in the USA?

https://imgur.com/HhGBqfZ

https://imgur.com/3ekdvUq

[Pugsy]

If a family member contracts the virus, it is almost certain that everyone in the house has as well.
Home use of a spare device might be recommended by a doctor,
since immediate spread has already breached the gate.

These are my thoughts on this as well.
If I were to come down with this virus and test positive...I have long ago already contaminated my bedroom for sure and most likely everything in my house and everyone in the house has been exposed....now they may or may not come down with it but the exposure has already happened and can't be undone and happened long before someone gets a positive test result.
Worrying about it now is like worrying about that barn door after the horse got out.

Now as to taking my spare cpap and loaning it out to be used on someone who isn't a cpap user and is ill with the virus to help them.
Like if my sister got sick with it.....that's a different story but she has likely already exposed everyone in her household. We could still try to do some extra measures to maybe mitigate the venting issue blowing the virus out in the room but accepting the fact that the contamination has already happened to the entire household anyway.
I would do it but only if her doctor said it would help her. I am not comfortable with using cpap to help anyone that is ill without a doctor being on board....but all I would need is a doctor to say "yes, it will help and not hurt" and I would do it gladly.

[raisedfist]

It depends on the severity of the illness. If you can't protect your airway or breathe spontaneously, it isn't going to help. If you otherwise just don't feel well, keep using your CPAP and sleep in a room by yourself.

[chunkyfrog]

It depends on the severity of the illness. If you can't protect your airway or breathe spontaneously, it isn't going to help. If you otherwise just don't feel well, keep using your CPAP and sleep in a room by yourself.

if you can, of course.