08 June 2020

Coronavirus Deaths due to Mistakes using Ventilators and BiPAP?

“If the world’s going to get better, it’s going to be up to you.”
- Barack Obama (Former President of the United States – 1961- ) 

Since last month’s blog post, Coronavirus or COVID-19 Deaths have increased by more 150,000 to more than 400,000 deaths worldwide. Could any of these deaths have been avoided? For those that have “recovered”, how many have suffered long-term damage to their lungs and will have ongoing serious medical issues including mental health issues? Are any of the Coronavirus Deaths and long term damage due to mistakes by the Medical Specialists? In particular, are any Coronavirus Deaths due to mistakes using Ventilators, BiPAP or Bilevel and CPAP machines?

To avoid confusion, BiPAP is a Registered Trademark owned by Philips Respironics. Bilevel refers to all other brands such as ResMed.

Over the next few Blog Posts, I will detail my concerns with some of the medical protocols being used and the mistakes that I believe are being made. In particular, the BiPAP or Bilevel and CPAP machine settings being used by the medical specialists in the treatment of coronavirus patients. 

As detailed on the previous blog post Coronavirus Deaths using Ventilators, BiPAP and CPAP, most people would now be aware that in the first few weeks when COVID-19 cases appeared, Ventilators were being used with very high pressure of up to 30 cmH2O in the treatment of patients. 

It has generally been acknowledged in the medical field that doing so was a mistake and caused the deaths of patients and long term lung damage to those that have recovered. This was due to the medical 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. Details are on the blog post Lack of Coronavirus Ventilators: Use Bilevel and CPAP. I believe that a number of these deaths were also due to the medical specialist having a lack of education and training and an understanding how these various machines truly work.

For this reason, in late March 2020, the medical protocols were changed such that the recommended highest pressure is 20 cmH2O or more for Ventilators and 15 to 20 cmH2O for BiPAP and Bilevel and CPAP Machines. 

Examples of current medical protocols being used during COVID-19 are at:

The explanation of my concerns with some of the medical protocols is going to be done on a practical level based on my own personal experience, patient comments and various research studies. There will be others with more knowledge and a medical background who can explain better from a technical point of view. 

I may be misunderstanding the medical situation as I am not a medical doctor working in the hospitals and have not looked at any patient history. However, I am hearing and reading articles and comments being made by various medical workers and patients. 

My concerns are being raised so that it may be that the medical protocols need to be reviewed and changed. Each person’s life is valuable and to be treasured. By raising my concerns, should just one life be saved and other patients do not suffer long term lung damage and other serious medical issues then writing this Blog has been absolutely worthwhile. 

On the previous blog post, I advised that an additional reason for the number of deaths is due to the lack of education and training of the sleep and respiratory medical specialists. 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? 

When a patients presents to a hospital due to COVID-19 and their medical condition is of low deterioration, one of the medical protocols is to use a nasal cannula with oxygen of between 1 l/min to 6 l/min. This protocol is noted in the Articles mentioned above. 

It is my belief that a number of these patients with obstructive sleep apnea are not being optimally treated. By receiving sub-optimal treatment, the patient’s medical condition may deteriorate faster and/ or not be recovering as fast as they could if they had better medical treatment. 

Why would using a nasal cannula with oxygen up to 6 l/min not treat optimally the patient with obstructive sleep apnea?  

As detailed on the blog post Coronavirus Deaths using Ventilators, BiPAP and CPAP, based on current global cases of COVID-19 cases of more than 7 million at 7 June 2020, an estimated 20% or 1.4 million people have been hospitalized. Of this total of 1.4 million people, more than 20% or 280,000 of the hospitalizations are people who have both coronavirus and obstructive or complex sleep apnea. 

Obstructive sleep apnea is when your airway is narrowed or closed and breathing is momentarily cut off. Central sleep apnea occurs when a patient stops breathing and there is no obstruction in the airway. Complex sleep apnea includes people who have both obstructive and central sleep apnea

Using a nasal cannula with oxygen at 1 l/min to 6 l/min will not be effective for most of the patients with COVID-19 and obstructive sleep apnea. To explain why this is the case, I will use my own personal experience when I had an eye tear duct DCR operation in 2015 with an overnight stay in hospital. 

The medical specialist anaesthetist refused to let me use my sleep apnea machine being bilevel auto adjusting pressure machine at night. I explained a number of times that I had to use the machine to stop obstructive sleep apnea! The medical specialist advised that using oxygen of 4 l/min was all that I needed. This happened after the specialist specifically asked me to bring the machine to the hospital and had personally looked at the machine. 

The look on the medical specialist face was “I am the medical specialist. What would you know?” 

As advised on the blog page Why is CPAP Compliance Rate Low?, 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 or Bilevel and CPAP machines truly work. 

That night, the medical specialist put me on oxygen of 4 l/min with the oxygen desaturation alarm set at 93%. For a majority of patients, a target saturation range of 94% to 98% is advised.

What do you think happened that night after the operation? 

I had one of the worse nights of sleep in my life! Due to obstructive sleep apnea and the loud oxygen desaturation alarm going off I was continually waking up during the night. Every time the alarm went off, a nurse would come rushing to see me to check that I was alright and would sometimes talk to me. It was a great waste of a nurse’s time which would not have been necessary had I been able to use my sleep apnea machine. I had to control my frustration from not getting any sleep. With no quality sleep I felt like getting out of bed and smashing the alarm into little bits!  

Why did oxygen not work? 

Obstructive sleep apnea is caused by closure in the airway. If you are having continual apneas during the night in particular from long and/ or from clusters of apneas together, your oxygen will normally desaturate below 93%. It is common for the oxygen desaturation rate to go below 90% for people with sleep apnea during the night.

A patient with COVID-19 may have their medical condition deteriorate quickly. You can see that where a patient has both COVID-19 and severe obstructive sleep apnea, the oxygen desaturation rate may drop below 80% or lower. 

Obstructive sleep apnea blocks the airway. How is oxygen going to go down the airway when it is blocked? The oxygen will not be going down the airway as 4 l/min is not enough force to open the airway. Hence, the oxygen desaturation alarm was going off all night! 

The specialist anaesthetist had more than 20 years’ experience. If this particular medical specialist can make this mistake, how many other medical specialists around the world are also making the same mistake? 

In the next blog post, I will look at the medical protocols being used for BiPAP or Bilevel and CPAP machines and the machine settings. 

During the Pandemic in the initial stages of a patient having COVID-19, I believe that the optimal treatment for many patients is to consider using the machine that I use, bilevel auto adjusting pressure machine with oxygen (when necessary). In addition, consider using similar settings that I use as outlined on the blog page Different Bilevel Settings Example.

By using a BiPAP or Bilevel machine rather than a CPAP machine, a patient can get the optimal treatment and the best of both worlds. Both COVID-19 and sleep apnea in particular obstructive sleep apnea will be covered with the optimal treatment from the moment the patient comes to the hospital. 

COVID-19 can progress quickly by rapid deterioration in a patient’s health. Every hour is critical in the treatment of a patient in overcoming the virus. By having great therapy and quality sleep, a person has more time to build up their immune system and resistance to the coronavirus. A patient may recover faster and leave hospital without the physical and mental scars from using a Ventilator. In addition, the current horrific death toll may be reduced. 

With patients recovering faster, more beds will become available in hospitals. Staff and equipment will be freed up as the demand will have reduced. We should also see a reduction in any mental issues currently being experienced by many health care workers.
If the world’s going to get better, it’s going to be up to you, the medical specialists to CHANGE it!  

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