“By failing to prepare, you are preparing to fail.”
At the date of writing this blog post, Coronavirus or COVID-19 has caused over 250,000 deaths. Ventilators, BiPAP and Bilevel and CPAP machines have been used in the treatment of patients. The deaths of many patients have been due to various factors including high pressure
settings and high tidal volume being used on the Ventilators. BiPAP and Bilevel machines should
have been used in the early stages of COVID-19 for a patient and for ventilators
to be used only when the patient’s medical condition became critical.
To avoid confusion, BiPAP is a Registered Trademark
owned by Philips Respironics. Bilevel refers to all other brands such as
ResMed.
Many reasons have been put forward for the number
of deaths including shortage of ventilators, China and the World Health Organization
(WHO), political leaders and senior health authorities of various countries and
lack of personal protective equipment (PPE).
An
additional reason for the number of deaths is due to the lack of education and
training of the sleep and respiratory medical specialists. I am not
criticising the individual emergency health care doctors, nurses and other
workers who have worked tirelessly with lack of personal protective equipment during
the COVID-19 pandemic to save lives.
In a previous blog post on 15 March 2020, Lack of Coronavirus Ventilators: Use Bilevel and CPAP, I advised that a number of common symptoms
of COPD (chronic obstructive pulmonary disorder) are similar to those of COVID-19. This is
the reason why I believe serious consideration should be given to using a
bilevel auto adjusting pressure machine with oxygen (where necessary) should there be a shortage or lack of ventilators.
In the settings of my own machine I have
used the principles of bilevel pressure being applied to COPD as detailed in
the blog post Different Bilevel Settings Example. Note that I have used tidal
volume of 6 ml/kg (or 6cc/kg) ideal body weight or predicted body weight.
I understand that the medical
protocol for ventilators being used initially during COVID-19 was the same as
during ARDS (acute respiratory distress syndrome).
Based on literature, the tidal volume was 4 ml/kg to 8 ml/kg predicted body weight
and maximum pressure of 30 cmH2O.
From late March 2020 with the use
of BiPAP and Bilevel machines in the early stages of COVID-19 for a patient rather
than a ventilator, the medical protocol for tidal volume is 4 ml/kg to 6 ml/kg and
maximum pressure of 20 cmH2O as detailed in a White Paper by Syneos Health.
It can be seen that both the tidal volume and maximum pressure have
reduced substantially when using BiPAP and Bilevel machines instead of
ventilators. Overusing ventilators has led to the deaths of patients and to
many news articles in April 2020.
An example of the articles published was on 28 April, 2020.
"A frontline
nurse working in New York on coronavirus patients claims the city is killing
sufferers by putting them on ventilators, advocating against them. COVID-19 patients are placed on ventilators rather than less invasive
CPAP or BiPAP machines due to fears about the virus spreading. The ventilators
have high pressure, which then causes barotrauma, it causes trauma to the lungs."
In a YouTube video posted, a New York emergency room doctor Cameron
Kyle-Sidell said:
'I've talked to doctors all around the country and it is
becoming increasingly clear that the pressure we're providing may be hurting
their lungs. It is highly likely that the high pressures we're using are
damaging the lungs of the patients we are putting the breathing tubes in. We
are running the ventilators the wrong way and calling for the protocols to be
changed. COVID positive patients need oxygen, they do not need pressure.”
An example of another news article was published on 21 April 2020.
"Starting this month, a few physicians have voiced concern
that some hospitals have been too quick to put Covid-19 patients on mechanical
ventilators, that elderly patients in particular may have been harmed more than
helped, and that less invasive breathing support, including simple
oxygen-delivering nose prongs might be safer and more effective."
"There is a growing recognition that some Covid-19 patients, even those
with severe disease as shown by the extent of lung infection, can be safely
treated with simple nose prongs or face masks that deliver oxygen. The latter
include CPAP (continuous positive airway pressure) masks used for sleep apnea,
or BiPAP (bi-phasic positive airway pressure) masks used for congestive heart
failure and other serious conditions."
"For one thing, the thick mucus-like coating on the lungs developed by
many Covid-19 patients impedes the lungs from taking up the delivered oxygen."
"In our personal experience, hypoxemia (low blood oxygen) … is often
remarkably well tolerated by Covid-19 patients, in particular by those under
60. The trigger for intubation should, within certain limits, probably not be
based on hypoxemia but more on respiratory distress and fatigue."
As noted in the previous blog
post; mucus, respiratory distress and fatigue are also symptoms of COPD and the
established treatment is to use BiPAP and Bilevel machines. A ventilator is to
be used when the patient is critical and having very severe breathing issues.
When I wrote the blog post, I thought there was only a shortage of
ventilators for use by critical care patients. I was very surprised to learn that
medical workers were using ventilators for the majority of patients being
admitted to hospital with COVID-19. This included those patients in the early
stages of COVID-19 where a BiPAP machine with oxygen (where necessary) would have been sufficient.
In addition, there would seem to be sufficient BiPAP and Bilevel
machines available at a far lower cost than ventilators. These machines are in
daily use by many people with sleep apnea around the world.
In another news article, it was mentioned that:
“While mechanical ventilators do not produce aerosols, they carry other
risks. Intubation requires patients to be heavily sedated so their respiratory
muscles fully surrender. The recovery can be lengthy, with a risk of permanent
lung damage.”
How did the
situation happen where the medical protocols are wrong and many people have
been put on Ventilators and died when BiPAP and Bilevel were sufficient?
The sleep and respiratory
medical specialists must take part of the responsibility and the blame for
Coronavirus or COVID-19 ventilators causing deaths and any permanent lung
damage to patients. One of the main reasons is due to the lack of education and training of the sleep and
respiratory medical specialists.
On the blog pages Why is CPAP Compliance Rate Low? and Secrets to Success: Answer is FREE, I mention that there is an estimated 80% or more than
15 million people who are non-compliant, failing and non-successful on sleep apnea
therapy. The sleep medical specialists and
the equipment suppliers say that the high non-compliance and failure may be due
to the patient. They take little responsibility for the high non-successful
rate of patients.
From various articles and from my own personal experience and from
others detailed on the various sleep apnea forums (listed on right hand side),
it is clear that a number of the medical specialists and others working in the
sleep industry are arrogant, lacking any understanding of the issues that
patients are facing and above all, have a lazy attitude to educating themselves
and their patients as to how sleep apnea therapy and BiPAP and Bilevel and CPAP
machines truly work.
The lack of education and training of these specialists is highlighted
on the blog page Guide to Success using CPAP and Bilevel. I spoke to 3 medical practitioners
regarding the high non-successful rate of patients and the reasons why they may
be non-compliant and failing. All 3 medical practitioners gave the same 2
reasons:
1. The
pressure is too high; and
2. The
machine does not work. That is, many patients felt that there was no
improvement in their continued sleepiness and fatigue.
From the news
articles quoted above, you can see that these two reasons are the same issues
that medical workers are facing with patients during the COVID-19 pandemic.
Unfortunately, in the current pandemic, many people have died or will have
permanent lung damage.
Support for the 2nd
reason above, is a comment made by Professor Susan Redline, Professor of Sleep
Medicine at Harvard Medical School.
“…it is estimated that as
many as 10% of patients with sleep apnea have some degree of continued
sleepiness/fatigue despite what seems to be optimal treatment of their sleep
disorder.”
Refer to the blog article on My
Apnea forum “6 months in, why don’t I feel better?”
This point was also referred to in an article by Dr Steven Park which
looks at CPAP compliance craziness.
As mentioned, there is an estimated 80% or more than 15 million people
who are non-compliant, failing and non-successful on sleep apnea therapy. Each
day on the various sleep apnea forums, there are hundreds and hundreds of
people at any one time for 24 hours every day seeking answers to overcome sleep
apnea therapy side effects and issues.
The medical specialists do not understand how sleep apnea therapy and the
various sleep apnea machines truly work. A great
example of the lack of
understanding is how to stop CPAP air through the eye tear duct and coming out of the eyes. This is in addition to the many CPAP side effects and
issues such as insomnia, weight gain and tiredness and lacking energy
issues when AHI (number of apnea events per hour) is less than 1.0.
The sleep
specialists have had many years to work out how to overcome and stop these
issues for the patient as the CPAP machine was invented 40 years ago by Dr Colin Sullivan in 1980.
How can the
specialists and other medical workers use ventilators, BiPAP and Bilevel and
CPAP machines when they do not understand how they truly work? How will they be
able to apply these machines successfully to the patients during the COVID-19 pandemic?
On the blog post Elite Athletes Need Bilevel, I advised that in my
younger years, I played a lot of competition sport. I am totally aware that it
is critical for an elite athlete to
maximize their performance and be able to perform on any given day at their
best. Just 1% to 2% from your best may be the difference between winning and
losing the game.
Should an elite athlete not perform successfully at university, state or
club level then it is highly likely that athlete will not be able to perform
successfully at international level when representing their country.
The sleep
and respiratory medical specialists have not performed successfully treating
sleep apnea for patients during normal times before the pandemic. During the
COVID-19 pandemic, how will the specialists and other medical workers be able
to perform successfully with many patients, especially those that have both
COVID-19 and sleep apnea or other serious health issues?
In a 2018 study, it was held that nearly 1 billion people or 20% of the
total world’s population may have obstructive sleep apnea between the ages of 30 and 69 with
5 or more events per hour (AHI). The number of affected individuals was highest
in China, USA, Brazil and India.
Based on global cases of COVID-19 of more than 7.0 million at 7 June 2020; more
than 1.4 million people or 20% have COVID-19 and obstructive sleep apnea! It is estimated 80% of patients who have been diagnosed with sleep apnea may have
obstructive sleep apnea. Obstructive sleep apnea is when the throat muscles
obstruct your upper airway, blocking air from entering and leaving your lungs.
Add in the remaining
20% of patients who have other types of sleep apnea including Central Sleep
Apnea (CSA) and complex sleep apnea (both obstructive and central apnea), the
total cases with both COVID-19 and sleep apnea is more than 1.75 million! This
number will increase further given many patients are elderly and over the age of 69 years.
The specialists will have to deal with a lot of patients and make many
decisions under enormous pressure in very quick time. At the same time, they
need to understand how to apply the ventilator or BiPAP and Bilevel or CPAP machine
to the patient. The decisions must be accurate and correct otherwise the
specialists may put the patient’s life at risk.
In the
current pandemic, you can see the potential for a lot of mistakes and for many
deaths and permanent lung damage to patients to occur. In addition, how much
anxiety, stress, pain and suffering have patients had which may have
contributed to their death or permanent lung damage?
This is due to the specialist and other medical workers using a
ventilator and not a BiPAP and Bilevel machine during the early stages of
COVID-19 for a patient. It is also due to a lack of education and training and
an understanding how these various machines truly work.
The lack of education and training of the medical specialists has been
highlighted in recent Facebook posts.
Professor
Ron Grunstein – Sleep Disorder Specialist
12 November 2019
“I would argue its
not just GPs who need more education, its also the specialists that the GPs
refer to! The guidelines for sleep medicine training are sup=optimal and need
to be updated.”
Integrated Sleep Health
3 March 2020
“We actually need more intelligence in humans first. Its time
to ramp up training in sleep medicine in Australia to 2 year training for all medical
specialties. The ridiculous situation of requiring exposure to only 30
non-respiratory sleep medicine cases to become a "sleep medicine
practitioner" is dangerous and completely out of touch with modern
requirements. Sleep specialists need training in obesity management,
psychiatry, neurology not just respiratory sleep disorders.”
As demonstrated by the evidence provided, it is highly likely the
medical specialists and other medical workers will not be able to perform successfully
during the pandemic. For this reason, I believe the sleep and respiratory
specialists must take part of the responsibility and the
blame for Coronavirus or COVID-19 ventilators causing deaths and any permanent
lung damage to patients. This is due to the lack of education and training of the sleep and respiratory
medical specialists.
I finish this blog post with one final question for you to reflect on:
How many
lives would have been saved and what would be the number of people not running the risk of a lengthy recovery
and permanent lung damage due to intubation IF the Sleep and Respiratory Specialists had better education
and training?
My concerns with some of the medical protocols being used and mistakes that I believe are being made during COVID-19 are also detailed on the following blog posts:
My concerns with some of the medical protocols being used and mistakes that I believe are being made during COVID-19 are also detailed on the following blog posts:
Should you be having side effects and issues with
your sleep apnea therapy; CHANGE what you are doing so that you can wake
up feeling refreshed and energized each day.
“Have courage. Be adventurous
and Go for it! Overcome your fear.”
- Mrhelpful
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