Using home CPAP machines to provide Non Invasive Ventilation to COVID-19 Patients

So at this point is seem like Covid-19 may swamp hospitals all over the world with patients that need respirators. There aren’t enough respirators or ICU beds, and combat-medicine style “triage” will be needed to decide who gets the scarce resources and who doesn’t. This is a terrifying scenario, but it seems like it’s quite likely to happen.

What should individual citizens do to prepare? If there’s no room in the hospital how will you take care of yourself if you get COVID-19 and start suffering from ARDS (Acute Respiratory Distress Syndrome)?

One way to deal with the respirator shortage is the possibility of using home CPAP machines and oxygen concentrators to provide “Non Invasive Ventilation” or NIV (breathing support with added oxygen) at home. America has millions of CPAP machines in individual homes. Sleep Apnea has been heavily diagnosed in the last decade, and CPAP machines are the default treatment. So if people are stuck at home and the hospitals are full, they might be able to self treat with a CPAP machine. COPD and many other lung conditions require oxygen, so oxygen concentrators are also present in some American homes.

Some doctors think CPAP might be a possible treatment for the ARDS (Acute Respiratory Distress Syndrome) that COVID-19 patients experience.

COVID-19 patients in Wuhan were given Non Invasive Ventilation, and reports suggest that Non Invasive Ventilation is being used extensively with COVID-19 patients worldwide, especially with less serious patients or when there are not enough ventilators.

In particular, in situations where there aren’t enough ventilators, or in early stages of ARDS, it’s possible that Non Invasive Ventilation may play a role in treatment.

However, there are a couple of big problems with Non Invasive Ventilation.

1) It is possible that, while it temporarily improved oxygenation and reduces the work of breathing, it doesn’t necessarily change the natural disease course.

2) The air pressure of CPAP is likely to aerosolize the COVID-19 virus,  infecting people around the patient. This is especially true if they are not wearing adequate Personal Protective Equiptment.

So, Non Invasive Ventilation isn’t ideal. But if you don’t have access to a ventilator, and you aren’t in a hospital, it might be better than nothing. The aerosolization risk of spreading the virus is not so important at home: anyone at home with the patient is almost certainly already infected. And improving oxygenation/reducing breathing work is a reasonable goal for first aid, which is what home treatment should be considered.

CPAP machines can be paired with oxygen concentrators to deliver oxygen enriched air to the patients lungs. In my next post I’ll document how to make a simple CPAP / oxygen concentrator rig for emergency use.