CPAP Used as Ventilation Support for Coronavirus Patients
Modified CPAP Image: jcl5m1 via GitHub
CPAP Used as Ventilation Support for Coronavirus Patients
The coronavirus pandemic has exhausted many resources used to treat and prevent the illness, and currently, ventilation systems are in shortage due to the rapid escalation of respiratory treatment needs among patient populations. But CPAP, BiPAP, and other sleep apnea treatment devices are being used as respiratory support when other ventilators are not available. Some patients and medical equipment servicers are even adjusting CPAP devices to better serve ventilation needs, but this of course requires extensive knowledge of the devices and how they operate, and should not be performed unless authorized. The FDA published a letter to healthcare providers addressing this need for alternative ventilation support and how to make the most of the equipment currently available. While the FDA urges both providers and the general public to take extra precautions regarding the safety and sanitization of medical equipment, authorities are thankful to have plentiful CPAP and BiPAP systems on hand for this unprecedented emergency response effort.
CPAP to the Rescue
COVID-19, an acronym for Coronavirus Disease 2019, is caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus) pathogen, which spreads through saliva or other bodily fluids, usually from contact with contaminated surfaces. According to the World Health Organization website, the most common signs of COVID-19 illness include respiratory symptoms, fever, cough, soreness or aching, and in some cases, severe pneumonia, but it is important to remember that these symptoms may not arrive for several days following an infection. While most cases of COVID-19 do not require hospitalization, some patients develop serious respiratory symptoms that can make it difficult to receive the oxygen needed for proper health and survival. In these cases, ventilators are used to assist breathing and provide the lungs and body with sufficient oxygen. While standard CPAP machines do not necessarily assist breathing in the same manner as respirators, they do however apply continuous airway pressure to keep the airway open and stop it from collapsing. Other types of PAP-therapy devices such as BiPAP or ASV systems use varying pressure levels to provide better support and match patient breathing rhythms. When standard ventilators are not available, these systems can be used as alternatives.
About 10 percent of coronavirus patients will require respiration support of some kind, and as a result of the rising number of cases, healthcare providers are running low on equipment and supplies. While medical equipment manufacturers are on high gear trying to supply the growing demand, some patients, called “makers,” are simply making their own open-source, do-it-yourself (DIY) devices. Some of these devices, such as those displayed on GitHub, cannot track oxygen delivery and may not be efficient enough to provide the support needed for coronavirus patients, but some individuals have designed quite sophisticated alternatives using feedback measures and sensors for alarms and warnings. Whether these devices are for personal use or for donation purposes, it is important to ensure that they abide by current laws and recommendations for 3rd party medical equipment servicing. While the president himself was quoted in the New York Times as saying “respirators, ventilators, all of the equipment—try getting it yourselves,” it was clear that this was easier said than done, leaving many patients without proper treatment until an alternative device such a CPAP or BiPAP system was supplied. This shows us how important these devices are and what people are willing to do to keep themselves and the public safe and healthy.
The CPAP machine has always been a versatile tool in the treatment of respiratory illnesses. In emergency care settings, PAP-therapy devices are routinely used to help with everything from asthma attacks and COPD to respiratory emergencies such as pneumonia, toxic inhalations, and drowning. In addition, some CPAP devices also allow medications (for example, bronchodilators) to be nebulized and administered along with the airflow. According to an article posted on the website EMS1.com, emergency medical service (EMS) providers are working to ensure that first responders are equipped with CPAP devices and are trained to use them for these types of emergency situations, especially during the coronavirus pandemic when CPAP can help to improve airflow in COVID-19 cases and provide relief to those with pneumonia.
As mentioned in our previous article on coronavirus prevention strategies for sleep apnea patients, CPAP is crucial for those with sleep apnea syndromes to maintain health and immune system functions, but precautions should be taken to avoid risk of infection during the current pandemic. As the FDA warned in their letter to medical staff and patient populations, as much social distancing and environmental controls should be implemented when using such equipment. For example, additional filtration should be used where feasible, and physical distancing should be encouraged at all times. Ventilation or CPAP without a properly filtered seal could potentially contaminate the air and increase the risk of transmission if patients are infected. For this reason, the American Society of Anesthesiologists issued recommendations actually discouraging CPAP use in situations where physical distance between patients is not possible. Officials warn that use of alternative ventilation devices could possibly increase the spread of infectious disease by aerosolizing the virus. Even when using proper filtration, distance is always recommended in order to reduce the chances of contagion in all circumstances.
These considerations, while absolutely crucial to the control and elimination of the COVID-19 pathogen, should not discourage sleep apnea patients from adhering to treatment. As medical professionals deal with the high demand for medical equipment and supplies, it is important for patients to maintain their own equipment as instructed on their user manuals and refrain from stopping or donating devices needed for their own treatment needs. Healthcare providers continue to urge patients to maintain current treatment protocols and not to make any changes without first consulting with a doctor, sleep specialist, or other medical professional. Safety measures should simply be part of the CPAP therapy routine, and not a reason for stopping or reducing treatment. Both Philips Respironics and ResMed offer cleaning instructions links for direct reference and downloading, and the AASM published a complete list of safety measures for CPAP patients, including links to other relevant resources. As long as proper cleaning and sanitization procedures are followed, the benefits of continuing with therapy can be immeasurable for those with sleep apnea, especially when comorbid conditions are present. But if you do suspect that you could have a COVID-19 infection, contact your medical provider as soon as possible. It is always better to err on the side of caution during a serious public health threat such as COVID-19. The sooner you are treated, the better off you will be, and whether or not you have been infected, CPAP may be the key to your survival.
American Academy of Sleep Medicine - https://aasm.org/coronavirus-covid-19-faqs-cpap-sleep-apnea-patients
American Society of Anesthesiologists - https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/coronavirus
BBC.com - https://www.bbc.com/news/business-51896168
Centers for Disease Control and Prevention - https://www.cdc.gov/coronavirus/2019-ncov/prepare/index.html
EMS1.com - https://www.ems1.com/ems-products/medical-equipment/airway-management/articles/ems-use-of-cpap-for-respiratory-emergencies-KmE2hA29ngEgp6JN/
FDA.gov - https://www.fda.gov/medical-devices/letters-health-care-providers/ventilator-supply-mitigation-strategies-letter-health-care-providers
FDA 3rd Party Servicing Report - https://www.fda.gov/media/113431/download
FDA Press Announcement - https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-continues-facilitate-access-crucial-medical-products-including
GitHub - https://github.com/jcl5m1/ventilator
The New York Times - https://www.nytimes.com/2020/03/16/world/coronavirus-news.html#link-608173f0
Vice.com - https://www.vice.com/en_us/article/5dm4mb/people-are-trying-to-make-diy-ventilators-to-meet-coronavirus-demand
World Health Organization - https://www.who.int/health-topics/coronavirus