CPAP is a good way to prevent someone from getting intubated later on. It doesn't reduce the risk entirely, but early and aggressive CPAP usage can definitely reduce the likelihood of a pt needing intubation further down the line (more common w/ asthma/COPD, but there is some evidence supporting its use w/ ARDS pt's as well)
In not sure this is true. CPAP/PEEP are used for first line mild ARDS. But it seems hard to find any conclusive evidence for efficacy. It definitely makes people more comfortable, but it's hard to say if the clinical efficacy is really there.
The evidence is stronger in the case of mild ARDS (early NIVPP reduces intubation rates), by the time it has progressed to moderate/severe ARDS, it's too late and NIVPP isn't going to do any good.
Apologies that I'm on my phone right now and don't have links at hand, but I have done some reading on this topic recently.
> Intubation rates did not exceed 35% in non-ARDS and mild ARDS and NIV may thus be used as the first-line ventilatory support ... By contrast, 84% of severe ARDS required intubation and NIV does not appear beneficial in this subset of patients ... In patients with moderate ARDS, NIV may be worth attempting in those having a PaO2/FiO2 ratio >150 in the absence of hemodynamic instability or altered consciousness ...
There are definitely significant shortcoming to that study (single facility, etc), but it definitely points in the direction of CPAP being a viable treatment, especially if it's used aggressively (initiated early, high PEEP, etc)
You used to be able to buy high quality CPAP machines on Amazon. I don't see them any more.
There are also streamlined processes to get the prescription. You take the machine home over night and they monitor your breathing remotely.
Years ago I successfully argued with a CPAP company about their jacked up rates and was able to find the exact same CPAP machine for about 1/3 the cost.
Good to know that I can also use it for a pandemic. ;-)
CPAP makes inhaling easier, but it makes exhaling harder. Some CPAP devices have a setting that drops the pressure when exhaling, but not all of them do.
CPAP devices don't require a prescription to buy in many places around the world. You can easily buy them online, and setting the pressure is very easy on many models. A prescription could be useful for figuring out the pressure you need, but it's pretty common for people in countries with shitty healthcare systems to just buy a machine and self-titrate.
In the case of ARDS (which is what the sickest coronavirus patients end up with), it's actually that expiratory pressure that's important (you wouldn't want to configure the CPAP to drop the pressure on exhalation).
With ARDS the lungs fill with fluid, which causes the little sacs in the lungs (where gas exchange actually happens) to collapse and 'stick' closed. The higher 'baseline' pressure[1] helps keep them open.
[1] This is known as "PEEP" or "Peak End Expiratory Pressure", i.e. the pressure in the lungs at the end of exhalation. For ARDS/pneumonia patients, you want high PEEP.
I use a cpap at home for sleep apnea and was on a bipap for about 48 hours when hospitalized for pnuemonia.
Machines cost about $500-1500 dollars. Do require a percription though.