A new era for respiratory therapy?

We need ‘the right therapies to go to the right people’
 - 
Friday, May 22, 2020

SAN DIEGO – The coronavirus pandemic has raised awareness of the different types of respiratory equipment available, particularly bi-level positive airway pressure machines, says Carlos M. Nunez, M.D., chief medical officer at ResMed.

Here’s what Nunez had to say about what COVID-19 is teaching us about these machines and how they can be used.

HME News: Is anything getting lost in translation with all of the newfound attention around ventilators, bi-level machines and even CPAP machines?

Nunez: Where it gets confusing is that almost every ventilator, including the most expensive ICU ventilators, has a CPAP mode where it delivers pressure like the CPAP devices used to treat sleep apnea in the home. For example, there is guidance out of the National Health Service in the U.K. about using “CPAP” in the treatment of COVID-19 patients, but they’re not talking, specifically, about the devices from home. They’re talking about ventilators or bi-level machines in CPAP mode. Bi-level machines span the gamut, from those being used in the home similar to a CPAP machine, to those being used in the hospital or home as a non-invasive ventilator. They’re often used to treat more diseases that require more advance respiratory support than CPAP.

HME: Due to the shortage of vents, it seems people are looking more closely at bi-level machines as a good option for some COVID-19 patients?

Nunez: There has been a lot of discussion, especially in hot spots like New York City, looking at how bi-level devices might fit in the care of COVID-19 patients. There are three areas where these devices make sense: 1.) They can be used in the acute phase of care, typically for those less severe cases who are still hospitalized, but who do not require invasive ventilation; 2.) they can be used to help a patient who is improving to transition off of invasive ventilation and out of the ICU to a regular hospital ward; and 3.) they can be used when someone is ready to be discharged from the hospital but may still need some support. 

HME: I’ve seen in the mainstream media concerns over using bi-level machines because they might spread the coronavirus.

Nunez: Someone on a CPAP machine, bi-level device or non-invasive ventilator, or even just receiving oxygen via a nasal cannula, typically exhales into the surrounding environment. The research shows there is a similar risk as that same person breathing, talking, coughing and sneezing. To mitigate the risk, hospitals are working to ensure they have appropriate PPE available for all of their staff, to protect them from all of the potential risks of droplet dispersion in the acute-care environment.

HME: Is there a way to modify these machines so they’re less risky?

Nunez: You can configure circuits for these bi-level devices so there is an anti-viral filter in the circuit before the exhalation vent. This minimizes the risk of droplet dispersion. We have included information about these types of circuit configurations in some of the clinical bulletins we’ve submitted to the FDA in the past few weeks.

HME: What’s the bigger picture of what this pandemic is teaching us about respiratory conditions and the equipment used to treat them?

Nunez: Beyond the pandemic, there may be opportunities to do some things to change regulations and payment policy in ways that allow the right therapies to go to the right people more efficiently. I think all this awareness will help us do a better job providing respiratory care, in general.