14 September 2020

Are BiPAP and Bilevel and Ventilators reducing Deaths during Coronavirus?

“Blinding ignorance does mislead us. O! Wretched mortals, open your eyes!”

-Leonardo da Vinci (Italian Inventor, Painter and Engineer – 1452 – 1519)

Since last month’s blog post, total Coronavirus or COVID-19 cases have increased to more than 29 million people and deaths have increased by nearly 190,000 to more than 929,000 deaths worldwide. This figure is increasing at an alarming rate! Are BiPAP and Bilevel ST machines and Ventilators used by medical specialists reducing Coronavirus or COVID-19 Deaths and long term damage to patients? 

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

On the blog post, Are CPAP and BiPAP Mistakes contributing to COVID-19 Deaths?, I mention that in the early stages of coronavirus and in the recovery stage to consider using a similar machine and settings that I use, being the ResMed S9 VAuto or AirCurve S10 Bilevel machine. There would seem to be plenty of these machines available as they are used by many people around the world.

Is there another non-invasive ventilation (NIV) machine that can be used during COVID-19? What could a medical specialist do should a patient’s medical condition deteriorate with coronavirus from when they were admitted to hospital?

On last month’s blog post, Are BiPAP and Ventilator Settings contributing to COVID-19 Deaths?, I advised that during the COVID-19 pandemic, due to the lack of or shortage of ventilators, medical specialists are converting BiPAP and Bilevel machines to Ventilators.  

An example on YouTube is:

ResMed VPAP ST for Invasive Mechanical Ventilation

https://www.youtube.com/watch?v=EnVp_HcE9lo

There are other machines including the Philips Respironics DreamStation BiPAP ST.

Are BiPAP and Bilevel ST machines and Ventilators reducing Coronavirus or COVID-19 Deaths and Long Term Damage to patients?   

During the COVID-19 pandemic, the answer is a resounding “YES” in particular the using of BiPAP and Bilevel machines and non-invasive ventilation as early as possible.

In an article dated 10 July 2020, Dr Lancelot Pinto said “at least 60-70 per cent of his Covid-19 patients recovered with only non-invasive care. 

Like most at the beginning of the pandemic, India had assumed that ventilators were crucial to save patients with severe illness. But as understanding of Covid-19 evolved, more doctors are using non-invasive techniques.

Health ministry data as on June 23 shows that only 4.16 per cent of COVID infected patients required ventilator support, while about 16 per cent needed oxygen.

Meanwhile, with production underway for 60,000 machines, India's initial alarm about ventilator shortages has now turned into a problem of surplus. Winded Indian manufacturers now hope that foreign markets with shortages will buy their ventilators.

https://www.straitstimes.com/asia/south-asia/fate-of-india-made-ventilators-up-in-the-air-as-non-invasive-treatments-become-main

Note the BiPAP and Bilevel ST machines can also be used with oxygen. For example the ResMed ST can use up to 15 litres/ Min making it an ideal machine during the COVID-19 Pandemic. The ResMed S9 VPAP Auto can take 4 litres/ Min. In addition to the BiPAP and Bilevel machines providing support for breathing and oxygenation, supplementary oxygen can be added or increased as necessary. 

In an article published online on 6 August 2020, using BiPAP and Bilevel ST machines during the COVID-19 pandemic was confirmed.

“In the setting of a ventilator shortage during COVID-19 pandemic, and in other resource-constrained situations, these devices may be considered as an effective alternative means for invasive ventilation.”   

Foster, B.E., Diaz-Abad, M., Hudson, A.J. et al. Invasive mechanical ventilation using a bilevel PAP ST device in a healthy swine model. Sleep Breath (2020). https://doi.org/10.1007/s11325-020-02141-x

One of the major issues that I have with the medical specialists is why it has taken more than 3 months to conclude that using BiPAP and Bilevel machines and non-invasive ventilation for 60% to 70% of coronavirus patients is the optimal treatment rather than using intubation and invasive mechanical ventilators. During this time many thousands of people have died or have long term damage such as to their lungs.

On 15th March 2020 on the Blog Post, Lack of Coronavirus Ventilators: Use Bilevel, I advised that a number of the common symptoms of COVID-19 or coronavirus were similar to COPD (Chronic obstructive pulmonary disorder) respiratory disorder and that a BIPAP and Bilevel machine were the best machines to provide optimal treatment to the patient.

In addition, many people are being admitted to hospitals with the combination of coronavirus, COPD and obstructive sleep apnea (OSA). 

In articles dated 1 September 2018 and 9 May 2014, bilevel positive airway pressure therapy is a viable and effective option for patients who struggle to breathe due to COPD exacerbations and those with COPD-OSA (obstructive sleep apnea) overlap.

It’s well known that chronic obstructive pulmonary disease (COPD) is a major worldwide disease and ranks as the third leading cause of death in the world—killing some 2.7 million people annually.

Independent of one another, these conditions directly and indirectly contribute to tens of thousands of American deaths every year. However, these two diseases can occur in a comorbid relationship known as OLDOSA syndrome (obstructive lung disease and obstructive sleep apnea), also known as OVS (overlap syndrome). Together, their negative effects can be even greater than their impact alone.

https://www.rtmagazine.com/disorders-diseases/chronic-pulmonary-disorders/copd/bipap-noninvasive-ventilation-copd/

https://www.rtmagazine.com/disorders-diseases/chronic-pulmonary-disorders/copd/deadly-duo-copd-and-osa-overlap/

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. I want to make sure to apply logic and reasoning and to think critically and question what is happening during the COVID-19 pandemic due to the enormous death toll and long term damage to patients.

This is one of reasons that I have explained my concerns with some of the medical protocols being used and the mistakes I believe are being made by medical specialists over a number of blog posts based on my own personal experience, patient comments and various research studies.

From the various blog posts in particular Coronavirus Deaths using Ventilators, BiPAP and CPAP published on 5 May 2020; reasons for the large number of deaths include the lack of education and training of the sleep and respiratory medical specialists and that the majority of sleep specialists do not regularly use the sleep apnea machines themselves. In addition, a number of the specialists are arrogant, have a lazy attitude to educating themselves and the patients and are not willing to really listen to the patient and the issues that they may be having using the sleep machine.

How will the medical specialists be able to optimize the treatment for their patients during COVID-19 when they do not understand how the various sleep machines truly work and many specialists do not regularly use the machines themselves?

I expect most of the medical specialists have not regularly slept with the BiPAP and Bilevel ST machine or used similar machine settings that they are using for patients during COVID-19. If they had used the machines or had listened better to patients pre COVID-19, they would have a better understanding of what the patient is going through and the using of high pressure, high pressure support or pressure assist and low inhale time (TI) on the machine together with the patient having a high breathing or respiratory rate.

As outlined on the previous blog post  Are BiPAP and Ventilator Settings contributing to COVID-19 Deaths?, such a situation outlined in the previous paragraph may have severe consequences for the patient such as death and long term damage to the patient during the COVID-19 pandemic. This situation is more likely to happen where a person has COVID-19, on medication and has other serious chronic medical conditions such as heart diseases, cancer and COPD (chronic obstructive pulmonary disease).

On the blog posts Why is CPAP Compliance Rate Low? and Secrets to Success: Answer is FREE, I advise that there is an estimated 80% or more than 15 million people who are non-compliant, failing and non-successful on sleep apnea therapy.

Go onto the various sleep apnea forums (listed right hand side) and you will see tens of thousands of people who have been getting sub-optimal advice from the medical specialists and are receiving terrible treatment from the sleep machines. The forums include people who the medical specialists have prescribed BiPAP and Bilevel ST machines which are now being used extensively during COVID-19. Go and have a look at “The Mess” that the medical specialists have created and caused around the world!

It is no surprise to me that the medical specialists have likely caused the deaths and long-term damage to many patients around the world during the COVID-19 pandemic!

                                        *************************************

On the ResMed Manual for ST Therapy, on Page 37 are the clinical indications:

- Neuromuscular/restrictive disorders

- COPD

- Obesity hypoventilation

https://www.scribd.com/document/367658947/Resmed-s9-and-10-Sleep-Lab-Titration-Guide-Amer-Eng-1

The BiPAP and Bilevel ST machines have been marketed as machines for those people with severe respiratory disorders such as COPD. From personal experience, these machines can be also be used for obstructive sleep apnea and central sleep apnea including treatment emergent central apnea.

Serious consideration should be given to using the BiPAP and Bilevel ST machines from “start” to finish” for a patient during COVID-19. That is, where a patient’s medical condition allows, from the time that the patient is admitted to hospital to when they may need to go on invasive ventilators.

For those hospitals having concerns over the cost of these machines; during COVID-19, many companies are making low-cost ventilators. Pre COVID-19, the retail price of the ST machines was more than US$5,000.00. During COVID-19, there is a temporary reduction in the price to below US$ 3,000.00. An example is the Philips Respironics DreamStation BiPAP ST Machine with Heated Humidifier.

https://www.cpapdirect.com/cpap-machines/philips-respironics-dreamstation-bipap-s-t-machine-with-heated-humidifier

How much do you think a basic BiPAP and Bilevel ST machine would cost to build?

The lowest cost that I have seen is an incredibly low US$75.00!

Low-cost, easy-to-build noninvasive pressure support ventilator for under-resourced regions: open source hardware description, performance and feasibility testing

Onintza Garmendia, Miguel A. Rodríguez-Lazaro, Jorge Otero, Phuong Phan, Alexandrina Stoyanova, Anh Tuan Dinh-Xuan, David Gozal, Daniel Navajas, Josep M. Montserrat, Ramon Farré

European Respiratory Journal Jun 2020, 55 (6) 2000846; DOI: 10.1183/13993003.00846-2020

https://erj.ersjournals.com/content/55/6/2000846

Though I was diagnosed with only obstructive sleep apnea, from personal experience many people would find that the ResMed ST machine is a great machine giving them quality sleep so that they can wake up each morning refreshed and energized.

Those people that like fixed pressure will find that by using more pressure support than maximum 3 cmH20 of a CPAP machine, for example 5 cmH2O or more; will be able to breathe much easier against the pressure and reduce the likelihood of constantly waking up during the night.

Using the Back-Up Respiratory Rate (BURR) will assist in stopping central sleep apnea including treatment emergent central apnea from occurring. The Trigger and Cycle breathing sensitivity and Rise Time settings will make the transition from exhale to inhale smooth and gentle. The ST machine has a lot of flexibility in how it can be used due to having the BURR and Rise Time features and the ability to add or increase oxygen to 15 litres/ minute. These features make the ST machine an ideal machine to use during the COVID-19 pandemic from when the person is first admitted to hospital.    

Should the patient’s medical condition deteriorate with coronavirus, the ST machine settings can be easily changed. From personal experience only two settings would need to be changed; the Back-Up Breathing Rate and the amount of Pressure Assist or Pressure Support to be used. Pressure assist or pressure support is the difference between IPAP (inhale pressure) and EPAP (exhale pressure) being used during sleep therapy.

During COVID-19, the setting of the ST machine will be simple and easy to use especially where there may be medical workers with insufficient experience using these machines. For example, this situation may be due to more qualified medical workers having become ill due to COVID-19. In addition, the ST machine will be a lot cheaper to buy and less costly to run than using an invasive ventilator and intubation due to less staff being required.

Having great sleep is critical for the patient to recover during COVID-19. The BiPAP and Bilevel ST machines will allow a patient to do so, providing the machine is set up correctly for the patient by the medical specialist.

By having great therapy and quality sleep, a patient especially the elderly will be able to build up their immunity system to best overcome the coronavirus. A patient may recover faster and leave hospital without physical and mental scars especially from using an invasive ventilator. Such treatment will reduce the horrific death toll and the current high death rate during COVID-19. 

Below are Articles that detail the importance of a patient having great therapy and quality sleep in the Intensive Care Unit (ICU)!

https://www.sccm.org/Communications/Critical-Connections/Archives/2019/The-Importance-of-Good-Sleep-in-the-ICU

https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132015000600539&lng=en&tlng=en

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:

Lack of Coronavirus Ventilators: Use Bilevel and CPAP 

Coronavirus Deaths using Ventilators, BiPAP and CPAP 

Coronavirus Deaths due to Mistakes using Ventilators and BiPAP? 

Are CPAP and BiPAP Mistakes contributing to COVID-19 Deaths? 

Are BiPAP and Ventilator Settings contributing to COVID-19 Deaths?

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

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