6 ms·

Any thoughts about using a regular sleep apnea CPAP device for this type of situation, where one has access to the pressure settings?

by trevyn 7y ago

inamberclad 7y ago
I have heard that these can aerosolize the virus, which is dangerous to other people. https://hackaday.com/2020/03/12/ultimate-medical-hackathon-how-fast-can-we-design-and-deploy-an-open-source-ventilator/ https://hackaday.com/2020/03/12/ultimate-medical-hackathon-h...
sigmaprimus 7y ago
CPAP stands for continuous positive airway pressure, one of the problem with SARS(Severe acute respitory syndrom) or Wuhan Fever is it stiffens the lungs making it hard to exhale. This in turn allows the lungs to fill up with fluid, a sort of viral pneumonia. I believe a ventilator uses a negative pressure or vacuum to assist with exhalation and air exchange.
- bearsnowstorm 7y ago
  Actually exhalation is passive, not active, in modern day ICU ventilation.
  - elric 7y ago
    Interesting. How does that work? Does the pressure drop to let air out or something?
    - haldujai 7y ago
      To keep it simple you have a device that increases pressure through a closed circuit to push air into the lungs, when its time to exhale it drops pressure (although is still positive pressure i.e PEEP) that is weaker than the natural recoil/elasticity of the chest wall combined with gravity in a supine patient and allows exhalation.
      - bearsnowstorm 7y ago
        Agree. I'd add that my comment above about exhalation being passive is true in adult ICU practice. In high frequency oscillatory ventilation (HFOV) exhalation is active (a piston actively creates a negative pressure in the breathing circuit). I understand this is still used quite a bit in neonates (though I don't do NICU, so not an expert) but has gone out of favour in adults in a big way due to the results of trials like OSCILLATE (https://www.nejm.org/doi/full/10.1056/NEJMoa1215554 https://www.nejm.org/doi/full/10.1056/NEJMoa1215554). Probably still used in some centres as a rescue therapy, but I haven't used it in years (we'd use VV ECMO for that purpose).
  - burfog 7y ago
    This infuriates me. It's cutting corners, reducing the quality of care. There are now portable iron lungs that fit like a turtle shell. They do both inhalation and exhalation. That should be the only acceptable standard of care.
bearsnowstorm 7y ago
- COVID-19 seems to be mainly hypoxic respiratory failure, not hypercapnic respiratory failure - NIV (Non invasive ventilation, CPAP is essentially a form of this) doesn't typically perform well (on a patient outcomes, mortality basis) for pneumonia with hypoxia compared with invasive ventilation. However, this is thought to partly be because NIV delays the decision to proceed with intubation and ventilation. If there is no ventilator available, that might change the value of NIV. - NIV will also likely cause aerosolisation of the virus facilitating spread if there are others in the area. Most sleep apnoea CPAP masks are vented which would probably make this worse (cf unvented masks commonly used on ventilators in an ICU setting) - Many sleep apnoea CPAP machines don't allow entrainment of supplemental oxygen, which would be likely to be needed in critical COVID-19 infection Source: I'm an intensive care specialist
- fghorow 7y ago
  Ok, so what is the best way, in your opinion, for a still healthy hacker/maker geek to contribute something (anything?) to helping our local ICUs from being overwhelmed with patients? Edited to add: Spoken as the Dad of a 28 week premie who spent 8 weeks on a ventilator in a NICU.
  - bearsnowstorm 7y ago
    As others have commented above, reducing the rate of spread (social distancing and hygiene, and convincing others to do likewise) so that this is a more smeared out event with a lower peak need for equipment and staff is the most important intervention. It's also very hard to do; not sure if there is a technological lever that will move the needle on this (advertising?)
    - fghorow 7y ago
      I'm a semi-retired Ph.D. scientist, and have already been doing Social Distancing for some time. My (frequently washed ;-) ) idle hands want to contribute something more! Since you are a professional in the field, I am asking your help for brainstorming useful, contributory things for people like me (and others) who are feeling the need to DO something. If hacking up ventilators (like in the OP) is not a great idea from your perspective, can you suggest anything else? And, THANK YOU for doing the job you do, from someone whose life was affected by people like you!
ode 7y ago
I heard an Italian doctor on the news yesterday saying they were using CPAP machines on (non-ICU?) CV patients in wards.
- UncleOxidant 7y ago
  I suspect this is because they're out of ventilators and CPAP machines are the only option they have left.
pujjad 7y ago
Someone dear to me needs a ventilator per tracheostomy (Trilogy 100). Her Consultant Aenesthesist who was in Italy four weeks ago and works on an Intensive Care Unit told me that 6 out 10 Covid-19 affected ITU patients require an ECMO (https://en.m.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation https://en.m.wikipedia.org/wiki/Extracorporeal_membrane_oxyg...). This is very bad. I could sense his unease, these are machines you don't come by easily. His ITU is preparing for war, Brexit and the conservative's austerity program has put the NHS to breaking point.
- OJFord 7y ago
  Well that's very not good, I hope it's much lower than that: https://www.theguardian.com/society/2020/feb/27/coronavirus-england-only-has-15-beds-for-worst-respiratory-cases https://www.theguardian.com/society/2020/feb/27/coronavirus-...
- microcolonel 7y ago
  > and the conservative's austerity program has put the NHS to breaking point. No such austerity has happened, and now is not the time for this petty bickering.
  - bigfudge 7y ago
    Bickering isn’t needed, but there is no doubt that many objective indicators of service quality and system stress in the NHS point to a decline. Vacancies in posts alone is a substantial concern and is directly linked to govt policies in training in recent years (withdrawal of the nursing student bursary for example). Denying the fact that the NH is under pressure isn’t helpful either... we need to be realistic about what to expect when we underfund our healthcare system.
    - thu2111 7y ago
      But the NHS is always 'underfunded' because demand for healthcare is infinite. Its funding has gone up continuously. There will never be a time when this isn't a political fight, that is, there's no level of funding that would end this bickering.

Any thoughts about using a regular sleep apnea CPAP device for this type of situation, where one has access to the pressure settings?

by trevyn 7y ago

Any thoughts about using a regular sleep apnea CPAP device for this type of situation, where one has access to the pressure settings?

inamberclad 7y ago

I have heard that these can aerosolize the virus, which is dangerous to other people. https://hackaday.com/2020/03/12/ultimate-medical-hackathon-how-fast-can-we-design-and-deploy-an-open-source-ventilator/ https://hackaday.com/2020/03/12/ultimate-medical-hackathon-h...

sigmaprimus 7y ago

CPAP stands for continuous positive airway pressure, one of the problem with SARS(Severe acute respitory syndrom) or Wuhan Fever is it stiffens the lungs making it hard to exhale. This in turn allows the lungs to fill up with fluid, a sort of viral pneumonia. I believe a ventilator uses a negative pressure or vacuum to assist with exhalation and air exchange.

bearsnowstorm 7y ago
Actually exhalation is passive, not active, in modern day ICU ventilation.
- elric 7y ago
  Interesting. How does that work? Does the pressure drop to let air out or something?
  - haldujai 7y ago
    To keep it simple you have a device that increases pressure through a closed circuit to push air into the lungs, when its time to exhale it drops pressure (although is still positive pressure i.e PEEP) that is weaker than the natural recoil/elasticity of the chest wall combined with gravity in a supine patient and allows exhalation.
    - bearsnowstorm 7y ago
      Agree. I'd add that my comment above about exhalation being passive is true in adult ICU practice. In high frequency oscillatory ventilation (HFOV) exhalation is active (a piston actively creates a negative pressure in the breathing circuit). I understand this is still used quite a bit in neonates (though I don't do NICU, so not an expert) but has gone out of favour in adults in a big way due to the results of trials like OSCILLATE (https://www.nejm.org/doi/full/10.1056/NEJMoa1215554 https://www.nejm.org/doi/full/10.1056/NEJMoa1215554). Probably still used in some centres as a rescue therapy, but I haven't used it in years (we'd use VV ECMO for that purpose).
- burfog 7y ago
  This infuriates me. It's cutting corners, reducing the quality of care. There are now portable iron lungs that fit like a turtle shell. They do both inhalation and exhalation. That should be the only acceptable standard of care.

bearsnowstorm 7y ago

- COVID-19 seems to be mainly hypoxic respiratory failure, not hypercapnic respiratory failure - NIV (Non invasive ventilation, CPAP is essentially a form of this) doesn't typically perform well (on a patient outcomes, mortality basis) for pneumonia with hypoxia compared with invasive ventilation. However, this is thought to partly be because NIV delays the decision to proceed with intubation and ventilation. If there is no ventilator available, that might change the value of NIV. - NIV will also likely cause aerosolisation of the virus facilitating spread if there are others in the area. Most sleep apnoea CPAP masks are vented which would probably make this worse (cf unvented masks commonly used on ventilators in an ICU setting) - Many sleep apnoea CPAP machines don't allow entrainment of supplemental oxygen, which would be likely to be needed in critical COVID-19 infection Source: I'm an intensive care specialist

fghorow 7y ago
Ok, so what is the best way, in your opinion, for a still healthy hacker/maker geek to contribute something (anything?) to helping our local ICUs from being overwhelmed with patients? Edited to add: Spoken as the Dad of a 28 week premie who spent 8 weeks on a ventilator in a NICU.
- bearsnowstorm 7y ago
  As others have commented above, reducing the rate of spread (social distancing and hygiene, and convincing others to do likewise) so that this is a more smeared out event with a lower peak need for equipment and staff is the most important intervention. It's also very hard to do; not sure if there is a technological lever that will move the needle on this (advertising?)
  - fghorow 7y ago
    I'm a semi-retired Ph.D. scientist, and have already been doing Social Distancing for some time. My (frequently washed ;-) ) idle hands want to contribute something more! Since you are a professional in the field, I am asking your help for brainstorming useful, contributory things for people like me (and others) who are feeling the need to DO something. If hacking up ventilators (like in the OP) is not a great idea from your perspective, can you suggest anything else? And, THANK YOU for doing the job you do, from someone whose life was affected by people like you!

ode 7y ago

I heard an Italian doctor on the news yesterday saying they were using CPAP machines on (non-ICU?) CV patients in wards.

UncleOxidant 7y ago
I suspect this is because they're out of ventilators and CPAP machines are the only option they have left.

pujjad 7y ago

Someone dear to me needs a ventilator per tracheostomy (Trilogy 100). Her Consultant Aenesthesist who was in Italy four weeks ago and works on an Intensive Care Unit told me that 6 out 10 Covid-19 affected ITU patients require an ECMO (https://en.m.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation https://en.m.wikipedia.org/wiki/Extracorporeal_membrane_oxyg...). This is very bad. I could sense his unease, these are machines you don't come by easily. His ITU is preparing for war, Brexit and the conservative's austerity program has put the NHS to breaking point.

OJFord 7y ago
Well that's very not good, I hope it's much lower than that: https://www.theguardian.com/society/2020/feb/27/coronavirus-england-only-has-15-beds-for-worst-respiratory-cases https://www.theguardian.com/society/2020/feb/27/coronavirus-...
microcolonel 7y ago
> and the conservative's austerity program has put the NHS to breaking point. No such austerity has happened, and now is not the time for this petty bickering.
- bigfudge 7y ago
  Bickering isn’t needed, but there is no doubt that many objective indicators of service quality and system stress in the NHS point to a decline. Vacancies in posts alone is a substantial concern and is directly linked to govt policies in training in recent years (withdrawal of the nursing student bursary for example). Denying the fact that the NH is under pressure isn’t helpful either... we need to be realistic about what to expect when we underfund our healthcare system.
  - thu2111 7y ago
    But the NHS is always 'underfunded' because demand for healthcare is infinite. Its funding has gone up continuously. There will never be a time when this isn't a political fight, that is, there's no level of funding that would end this bickering.