“If the world’s going to get better, it’s going to be up to you.”
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.
Example of
current medical protocols being used during COVID-19 is 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.
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:
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