Unprecedented Events do not Always Call for Unprecedented Actions
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EDITORIAL
Unprecedented Events do not Always Call for Unprecedented Actions Deepak Shrivastava1 Published online: 25 May 2020 © Springer Nature Singapore Pte Ltd. 2020
COVID-19 is a global disaster that could have been mitigated around the world a bit sooner and would probably not cost so many human lives! COVID-19 has affected the practice of Sleep Medicine in more than one way. Along with severe illness defined by the presence of shortness of breath and hypoxemia and critical illness defined by multiorgan failure, the spotlight focused on the need for mechanical ventilation and their staggering short supply. In the world of sleep medicine, there has been significant progress made in non-invasive ventilator technology. Continuous Positive Airway Pressure (CPAP) machines were seen as ventilator alternatives. In the setting of a highly contagious pandemic, the spread of the SARS-CoV-2 by aerosol was more than a hypothesis. In a Washington State nursing home, CPAP therapy was suspected to have caused the spread of COVID-19 in the residents. The American Society of Anesthesiologists issued guidance discouraging CPAP use in COVID-19 patients. Further recommendation came regarding the use of CPAP and similar devices in patients with sleep apnea, neuromuscular diseases, and other indications. Either patients could isolate themselves within their house if symptomatic, to protect their family or if possible, to discontinue the use of CPAP and adopt alternate therapies and take drowsy driving precautions until favorable public health advisory is issued. The emergency plans that developed as a consequence included COVID-19 patient triage for resource allocation [1], mass reclamation, and reprogramming of CPAP machines by firmware upgrades, asking patients who owned CPAP and similar machines to donate to hospitals, and connecting multiple patients by air tube splitter to a single ventilator. The U.S. Food and Drug Administration (FDA) emergently approved for the modification of respiratory devices to prevent aerosolization. A plastic bell-like helmet with a rubber collar seal is proposed to replace high leak risk face * Deepak Shrivastava [email protected] 1
University of California at Davis, Sacramento, CA, USA
mask [2]. Besides, with fewer features, CPAP machines can be mass manufactured in large quantities than hospital ventilators. The initial excitement is somewhat tempered by the recent observation that critically ill COVID-19 patients need lower positive pressures to inflate lungs as opposed to Acute Respiratory Distress Syndrome (ARDS), have silent hypoxemia reflected by tolerable work of breathing, highly recruitable lungs and favorable response to a prone position. According to a new study published in The American Journal of Tropical Medicine and Hygiene [3], by less use of ventilators, the death rate could be reduced by more than 50%. It is important to realize that ventilator-associated acute lung injury is well known and may occur with overinflation in a lung with near-normal compliance. A group of
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