There have been several threads on treatment of pandemic flu with prescription & non prescription drugs. I’d like to have a discussion of treatment of pandemic flu with home oxygen and CPAP and any other advanced measures. This comes with the disclaimer that this is only being considered in the event of a pandemic when medical help will not be available due to an overloaded medical system. A poster on another thread mentioned they bought an oxygen concentrator and finger oximeter. Several others have mentioned using their CPAP machines to aid the breathing of ill family members. My question is - for those that have this equipment, how do you plan on using it? When do you administer oxygen or CPAP, and what sorts of settings do you plan on using? Does anyone have any idea if this will do any good for the ill? Thanks!
Thanks, fredness!
Now, if someone opens those threads in different browser windows and comes to this window to post some kind of quick summaries (or copy-paste main points) that would be even more helpful - building on each other’s work!
Curious - I don’t know if I was the poster you saw, but I have on other occasions explained that my youngest child was born with respiratory problems. Through the years we have acquired a C-Pap machine, an oxygen concentrator, a Pulsox machine that measures both oxygen level and heart rate, a finger oximeter that does the same, and a homefill concentrator that can refill oxygen tanks for travel (he travels with one to school everyday). We have used this equipment to alert us when his oxygen drops to dangerous levels and he must be rushed to the nearest hospital and intubated. Because he has a diagnosed medical condition, our insurance covers 80% of the cost of this equipment which can be very pricey. There are, however, websites where you can purchase this equipment, sometimes at a very high price and sometimes at a lower price for used or remodeled equipment. I don’t think you always need a prescription. Good luck.
O2 would probably make a pt more comfortable. O2 is often used as a comfort measure. Would it change the outcome probably not in the vast majority of cases. CPAP might buy a few hours, till [or if] a vent became avail. You really dont need a pulse ox. If someone is a victim of H5 your going to be able to see the resp. distress, you wont need the machine to tell you they are in trouble. I wouldnt spend the money for one.
If you choose to get O2 learn about its use, saftey measures, and delivery systems.
If I remember correctly the fatality rate is very high for people with ARDS (over 80%?). That kept me from rushing out to try to buy any of this eqpt. I see there is a lot of room for improvement on the ARDS page (new research but little promising results). http://www.fluwikie.com/pmwiki.php?n=Consequences.ARDS
There are many medications that have been researched and almost none have worked consistently. That is not to say all patients with H5N1 infection will develop viral pneumonia or ARDS. If there is a chance that a resource that is available can offer support by all means we need to explore it application for this problem.
Quoting RespiratoryTherapist “There are two very important factors in ARDS/ALI that are of point here. One is that ARDS eventually causes systemic hypoxaemia by shunting (perfusion in excess of ventilation, where alveoli are fluid filled and cannot transfer O2 to capillaries). O2 is of benefit to maintain systemic saturation. The other is alveolar hypoxia. Alveolar cells extract O2 from inhaled gases. If the mixture is low or absent of O2, the Type I and II cells become hypoxic themselves, which perpetuates Acute lung Injury. Oxygen delivery early would be beneficial at mitigating the effects of ALI. The clinical plan would be to place ALL positive victims on O2 as early as possible, even in the absence of low arterial saturations,”
I decided to monitor my heart-rate and O2 after getting pneumonia (maybe, they never figured it out and never gave me a flu test either, BTW) and my siblings and I seem to have a sleeping O2 problem anyway. I have sleep apnea as well.
I went to an advanced CPAP with laptop history download which allows me to track my breathing paterns and autoadjusts pressure, and these machines are used when sleep studies are hard to do (supposedly because proximity or inability to sleep in strange paces, but when you have an HMO, trying to get them to pay for one is the real problem). I love it. The auto-adjust handles altitude changes and is just easier on you. and really helps with dealing with being sick and congested, which changes my apnea pressure needs (with Autopap design, you just set a high and low pressure, and it adjusts itself - I wonder what these algorythms would do with lung obstructions instead of airway obstructions, but I’d try it - you can set it to constant pressure at a single level if you like. Buy it online and get the clinician code to get to the settings). I have ResMed Autoset Spirit APAP with integrated humidifier - be sure to get a humidfier. It will operate on 12 VDC (use a deep discharge RV battery but it does not try to run the humidifier heater on the 12 VDC power) I have found the REMSTAR products to be much lower quality, design, and lifetime than RESMED. http://tinyurl.com/waff8 Haven’t used any other brands. http://www.talkaboutsleep.com/ for an informative forum on CPAP and other sleep issues.
I would not have spent $400 or more for an O2 reader but I found this fingertip one for for $232 with overnihgt shipping ( and I have seen it for about $200 without shipping). I have found the constant reading pulse to be very handy, but the O2 info has been reassuring a few times when I had some ill feelings during recovery. Works well, a little more bulky than $600 models but not uncomfortable to keep on your finger, and does work on all sizes. http://tinyurl.com/y8588z
I bought a rebuilt oxygen concentrator for $200 ($240 with shipping to California) from this rebuilder in MO (they do need a prescription, but maybe you could say its for jewelry-making). They even repour the oxy-filter and it seems to run fine now for 3 months. It took about 3 weeks to receive, they rebuild it when you order it. I use it at night. The $200 model (max 3 LPM-Litres Per Minute) is very clunky basic unit, a little smaller but no lighter than the nicer $350 units (max 5 LPM). I bought it because partly because I am looking at paying $500 out of pocket due to insurance idiocies for the use of one a long time ago. I am going to get a $350 dollar unit as well, you could split the 5 LPM between 2 people to give some comfort if oxygen helps, or 1 person at 5 LPM if very ill. If you have power. And you can make jewelry. Some fitness nuts say sleeping with oxy now and then is invigorating, and I think so. Get a little plastic T-adaptor hooks it to your CPAP hose if you use a CPAP machine. http://www.acbio.com/reconc.htm
If you stop breathing for even short amount of times while asleep, or snore heavily, get a sleep test. It changed my life, I do not ever try to sleep or nap without my CPAP. Especially my Autopap. Or if you get the fingertip Oxymeter above, wear it while asleep and have your sweetie check it when you are deep asleep or snoring - if gets to 88 saturation while asleep, I’d get checked. Others may know a better figure.
Fiddlerdave - Great information for people. Thanks for reminding people to get a sleep apnea test if they think they have any breathing problems at night. My son has had several through his lifetime. Apparently children who are born with his syndrome usually die by the age of two so we are really lucky. He is 15.
I think that another good source for used equipment would be health care vendors. I think that some are willing to sell used equipment at a reduced price without a prescription, because I’ve had different technicians offer us products at half price.
fredness is right in that hypoxia exacerbates lung injury.
The thing about ARDS is that it carries a very high fatality, and we don’t really know if early action with anyone having respiratory difficulties will prevent progression to ARDS.
I’m not a respiratory specialist, but it seems to me that if most people are unlikely to be able to get admitted to hospitals, then very early action in the hope of preventing progression to ARDS is the only option available. In that context, early use of oxygen, prone positioning, and CPAP, would make a lot of sense.
This may be off thread some-but I believe the prevention is the key as well. I think inhalers with a steroid would keep the lower air sacs open especially for folks with known respiratroy disease. The inhalant along with an antibiotic (if you have one) would be great prevention if you don’t have access to oxygen. When the hospital runs out of incentive spirometers (devices to build lung volume) we tape gloves onto the barrel of a 30–50cc syringe and have the patient sit up in bed, take deep breaths, and exhale into the barrel to inflate the glove. The idea is to avoid weaker upper chest breathing and keep the lower lobes of the lungs open.