COVID 19, CPAP, Ventilator MEGA THREAD...everything go here please

[palerider]

I'm long overdue for a new machine. I have been getting the vpaps and the last one was the S9 auto vpap. Would it be smart to get an AirCurve 10 ST-A in case i ever need it and what would it take for a Dr, to prescribe that? I wonder if slight COPD is enough. My sleep Dr. is an ENT and I have a feeling I would need a pulmonologist for that machine.

No, it wouldn't. the ST-A is a specialized machine, primarily for people with lung diseases, it doesn't treat sleep apnea all that well.

You'd be better off with the newer edition of the machine you're used to, which would be the AirCurve 10 VAuto.

[Miss Emerita]

Researchers from the Mechanical Engineering department at UC Berkeley and from UC San Francisco (a medical school) are collaborating to outfit PAP machines so that they can be used as ventilators. The faculty leads are Grace O'Connell (UCB, ME) and Bertram Lubin, associate dean of Children's Health, UCSF. The web site is very rudimentary, but you'll find at least some information at the link below. They are seeking donations of PAP machines that people aren't using, more here:

https://www.helpventilator.com/

[Wulfman...]

New "social distancing" measurements.




Den

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[jstjohn]

I can't accept the argument that CPAP/BIPAP machines cannot be used, in some cases, to ventilate patients. Haven't we all seen the doctors explaining how, in the event that a ventilator is unavailable, a person periodically squeezing a rubber bag can be a substitute for a ventilator?

Invasive ventilation is preferred in hospitals because patient secretions can be contained, thus it is safer for staff to be around those patients. I recently heard, sorry can'
t remember the source, that the FDA has relaxed rules to temporarily allow hospitals to use CPAP/BIPAP machines and oxygen concentrators in place of standard ventilators and wall oxygen.

And yes, I can definitely see the very real possibility that in some areas of this country, for some periods of time, hospitals may be so overwhelmed that they will simply turn patients away, or if they admit them, they won't be able to provide treatment. So, 'going to the hospital', while certainly the preferred choice now, may not be an option at some point.

[raisedfist]

How can I change my parent's hygiene habits even more? They are better now in terms of keeping distance, not touching others, not going out nearly as often, washing their hands more often. But I still see them picking their nose, sometimes coughing out in the open at home, rubbing their eyes, licking their fingers while eating, etc,. My parent's are twice my age so IDK how to approach the situation.

They see that normal age and young people are getting real sick and sometimes even dying, but they still overall think they are more or less invincible since they are mid 60's and overall somewhat healthy (no drastic underlying conditions). But they've never dealt with pneumonia or respiratory illness.

I feel like since we haven't even peaked in the worst hit areas yet, the coming weeks are even more critical for not getting sick. If you're gonna get a bug, the time would be at least when a usable antiviral is out, and the hospital is at least not completely swamped with sick people.

I've already tried to lead by example, bringing up multiple times now that my nails are growing and healthy because I stopped putting my fingers in my mouth.

[raisedfist]

I can't accept the argument that CPAP/BIPAP machines cannot be used, in some cases, to ventilate patients. Haven't we all seen the doctors explaining how, in the event that a ventilator is unavailable, a person periodically squeezing a rubber bag can be a substitute for a ventilator?

Invasive ventilation is preferred in hospitals because patient secretions can be contained, thus it is safer for staff to be around those patients. I recently heard, sorry can'
t remember the source, that the FDA has relaxed rules to temporarily allow hospitals to use CPAP/BIPAP machines and oxygen concentrators in place of standard ventilators and wall oxygen.

And yes, I can definitely see the very real possibility that in some areas of this country, for some periods of time, hospitals may be so overwhelmed that they will simply turn patients away, or if they admit them, they won't be able to provide treatment. So, 'going to the hospital', while certainly the preferred choice now, may not be an option at some point.

AFAIK the most common hospital BiPAP from PR is the V60, which indeed I have seen reports of being used in the hospital now but I am sure sparingly and only in the current hot spots like NYC. More in the proof of concept in preparation stage. I have heard of them mostly being used for non-COVID 19 patients, for the people with chronic respiratory issues that come in for exacerbation. I don't know all the details, but they attach a special type of filter and use a circuit that allows a non-vented mask, since there's a separate exhalation valve with an active circuit, not sure if it's a closed system or not. They ventilate this patient with the AVAPS feature, and oxygenate them using a combination of PEEP and perhaps bled in O2. I think the one limitation of V60 is you can't control FiO2 (fraction of inspired oxygen), but don't quote me on that as I am a newbie.

From what I've seen from RT's is that because the pneumonia leads to ARDS, they are following the ARDS protocols which generally call for moderate tidal volumes, high PEEP, and capping inspiratory pressures at 30 cmh2o or below, to protect the lungs from injury.

When you truly need mechanical ventilation is when you can't breathe spontaneously, can't protect your airway, can't clear secretions, etc.

[babydinosnoreless]

Can someone explain what is peep ?

[DreamDiver]

Can someone explain what is peep ?

positive end-expiratory pressure

PEEP: Abbreviation for positive end-expiratory pressure. A method of ventilation in which airway pressure is maintained above atmospheric pressure at the end of exhalation by means of a mechanical impedance, usually a valve, within the circuit. The purpose of PEEP is to increase the volume of gas remaining in the lungs at the end of expiration in order to decrease the shunting of blood through the lungs and improve gas exchange. PEEP is done in ARDS (acute respiratory failure syndrome) to allow reduction in the level of oxygen being given.

[jnk...]

I can't accept the argument that CPAP/BIPAP machines cannot be used, in some cases, to ventilate patients. Haven't we all seen the doctors explaining how, in the event that a ventilator is unavailable, a person periodically squeezing a rubber bag can be a substitute for a ventilator?

And I can't accept the argument that the band aid used after getting a shot can't be used, in some cases, to stop the bleeding of a severed limb. Haven't we all seen doctors explaining how, in the event of an emergency, you could use your leather belt as a stop-gap tourniquet and use a temporary bandage of cloth to help stop the bleeding if miles from civilization? So why not just use a band aid like is used after a shot if you can't get to a hospital for a few days with a severed limb? I mean, it's better than nothing, right?

I guess I could decide to do that to myself based on my rights to do whatever I want to my own body. But why would I post it to confuse others facing life-threatening issues needing responsible decisions?

Let docs make doc decisions. Let experimental researchers do experimental research with rigging machines every which way for emergencies. But only encourage others to use a home sleep-treatment machine to treat sleep at home. Don't plant ideas about others deciding to use a home sleep-treatment machine for any of their respiratory failures, severe pneumonias, or severed limbs, no matter how much you might want to talk theoretically on a public forum about your ideas for improper, unapproved, and likely meaningless uses of home CPAP just because it sounds similar to what is used for other more serious acute medical issues that come up in emergency rooms and ICUs.

Hey, just me.

[ChicagoGranny]

I can't accept the argument that CPAP/BIPAP machines cannot be used, in some cases, to ventilate patients.

There are no reports of patients who need ventilators not being able to get them.

During both Monday and Tuesday nights Coronavirus Task Force press briefings, Dr. Birx has emphatically stated that anyone who needs a ventilator will be able to get one.

You should watch some of the meetings of the task force on C-SPAN. They usually start at 5:00 p.m. or a little later. I like to record them and then fast forward through Trump and listen to Dr. Birx and Dr. Fauci.

BTW, you say "in some cases". Could you be specific?

[babydinosnoreless]

Can someone explain what is peep ?

positive end-expiratory pressure

PEEP: Abbreviation for positive end-expiratory pressure. A method of ventilation in which airway pressure is maintained above atmospheric pressure at the end of exhalation by means of a mechanical impedance, usually a valve, within the circuit. The purpose of PEEP is to increase the volume of gas remaining in the lungs at the end of expiration in order to decrease the shunting of blood through the lungs and improve gas exchange. PEEP is done in ARDS (acute respiratory failure syndrome) to allow reduction in the level of oxygen being given.

Thank you !

[raisedfist]

I can't accept the argument that CPAP/BIPAP machines cannot be used, in some cases, to ventilate patients.

There are no reports of patients who need ventilators not being able to get them.

During both Monday and Tuesday nights Coronavirus Task Force press briefings, Dr. Birx has emphatically stated that anyone who needs a ventilator will be able to get one.

You should watch some of the meetings of the task force on C-SPAN. They usually start at 5:00 p.m. or a little later. I like to record them and then fast forward through Trump and listen to Dr. Birx and Dr. Fauci.

BTW, you say "in some cases". Could you be specific?

Dr. Fauci is fantastic the way he delivers information. Trump is like 60 minutes of "we're doing a great job" lol although to be fair many of the reporters are asking very loaded "questions."

IMHO New York City is paying for not taking things seriously early enough. They need ships and pop up hospitals because two weeks ago the mayor was telling people to go out and live their life, not to mention taking his usual trip to the gym. Idiots are still congregating to check out the ships, not just essential workers are out and near others. The mayor and the governor wasted time debating a shelter in place order. It doesn't help with the density and huge disparity in resources depending on zipcode.

California and Washington are doing better. The goal now is to not become New York. Thankfully my governor is seemingly doing a good job, although supply wise things may get interesting in two weeks when things are near or at the expected peak.

Those states without shelter in place orders I feel sorry for the people doing what they are supposed to do.

[jstjohn]

I can't accept the argument that CPAP/BIPAP machines cannot be used, in some cases, to ventilate patients. Haven't we all seen the doctors explaining how, in the event that a ventilator is unavailable, a person periodically squeezing a rubber bag can be a substitute for a ventilator?

And I can't accept the argument that the band aid used after getting a shot can't be used, in some cases, to stop the bleeding of a severed limb. Haven't we all seen doctors explaining how, in the event of an emergency, you could use your leather belt as a stop-gap tourniquet and use a temporary bandage of cloth to help stop the bleeding if miles from civilization? So why not just use a band aid like is used after a shot if you can't get to a hospital for a few days with a severed limb? I mean, it's better than nothing, right?

I guess I could decide to do that to myself based on my rights to do whatever I want to my own body. But why would I post it to confuse others facing life-threatening issues needing responsible decisions?

Let docs make doc decisions. Let experimental researchers do experimental research with rigging machines every which way for emergencies. But only encourage others to use a home sleep-treatment machine to treat sleep at home. Don't plant ideas about others deciding to use a home sleep-treatment machine for any of their respiratory failures, severe pneumonias, or severed limbs, no matter how much you might want to talk theoretically on a public forum about your ideas for improper, unapproved, and likely meaningless uses of home CPAP just because it sounds similar to what is used for other more serious acute medical issues that come up in emergency rooms and ICUs.

Hey, just me.

First, I'm not encouraging anyone to do anything. The original topic of this thread, and the topic to which my post was directed, was the feasibility of converting a standard CPAP machine into something that could be used as a ventilator. We're talking about pushing air through a pipe, not about building a nuclear reactor. And before the deluge of negativity starts, I get that the high-tech ventilators have a high level of sophistication. But at the end of the day it's about moving air and oxygen through a pipe at a certain volume, pressure, and timing.

Mechanical ventilation goes back a long time, remember the iron lung? Crude, yes, primitive, yes compared to today's technology but it saved a lot of lives. I have never opened up a ventilator to see what's inside. But I would bet that the number of high tech parts is zero or near zero, and I suspect the total parts cost is maybe 2-3% of the selling price.

This is not about what any individual should do, it's simply a THEORETICAL discussion of the feasibility of adapting a device that exists today in large quantities to do the job of a similar device that is more high tech but not readily available. You know, like maybe if we were faced with a medical crisis?

The comments about 'everyone who needs a ventilator is getting one' (not your comment) are all well and good, right up until the time that the ventilators run out. That time will come in the next few weeks. Doctors in some areas will have to make tough decisions about who gets a ventilator and how long they are allowed to stay on it. To believe otherwise is naive.

[jnk...]

at the end of the day it's about moving air and oxygen through a pipe at a certain volume, pressure, and timing.

Which is like saying "at the end of the day, surgery is just about sticking knives into people at a certain depth, frequency, and location."

In fact, anyone have any ideas how I can modify my bedroom ceiling fan into a CPAP machine, in case of emergencies? I mean, at the end of the day, they're both about about moving air around in my bedroom, right?

[klm49]

From this web site.
https://www.rollcall.com/2020/04/01/hos ... age-looms/