- COVID-19, a disease resulting from infection with SARS-CoV-2, has required the healthcare system to provide respiratory support for a significant number of people with moderate-to-severe symptoms.
- People with COVID-19 may need supplemental oxygen, assistive breathing devices, or the use of a ventilator to be able to breathe.
- Experts are still developing recommendations for types of oxygen delivery and respiratory assistance.
- Some research efforts are focusing on making oxygen delivery methods more cost effective and available in areas with limited resources.
Infections with SARS-CoV-2 are ongoing, with more than 38 million total cases of COVID-19 in the United States since the pandemic started.
Hospitals and other healthcare facilities are continuing to find innovative ways to supply people with the care they need, including developing simpler ways to support breathing.
One recent report that appears in Frontiers in Medical Technology explains the development of a lighter, easier-to-use, and simpler form of a continuous positive airway pressure (CPAP) device. This device could serve to help ease the breathing of people with COVID-19 in areas with limited oxygen resources.
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COVID-19 and oxygen recommendations
Research is ongoing regarding methods of oxygen delivery and the most effective intubation practices to provide the best possible care to patients.
Methods to provide people with oxygen
Healthcare professionals can provide the respiratory help and oxygen that people with COVID-19 need in
- Nasal cannula: A thin tube delivers oxygen into the person’s nostrils, often at low rates.
- Face mask: A mask that sits on the person’s face can give varying amounts of oxygen depending on the setup.
- High flow nasal cannula: A
high flow nasal cannulais a specialized nasal cannula that allows a person to get up to 100% oxygen while still maintaining their ability to talk and eat.
- Continuous positive airway pressure (CPAP): This method uses a specialized machine and mask to keep the airway open and ease the work of breathing.
- Mechanical ventilator: This machine mechanically pumps oxygen into the lungs.
Depending on a person’s need, healthcare professionals can adjust the concentration of inspired oxygen, or “fraction of inspired oxygen” (FiO2), for many methods of oxygen delivery.
The most recent guidelines from the National Institutes of Health (NIH) recommend using the high flow nasal cannula over methods of noninvasive positive pressure ventilation, such as CPAPs.
However, research is ongoing regarding the use of these devices to help people with COVID-19 breathe. Preliminary findings from the Recovery-RS trial indicate that people with COVID-19 who used CPAP devices in treatment were less likely to be intubated.
Prof. Nicholas Hart, a clinical and academic director for Lane Fox Respiratory Service, explained to Medical News Today: “Recent unpublished data from a UK RCT (RECOVERY-RS) has demonstrated that CPAP reduces the need for intubation, but not mortality, in middle-aged COVID-19 patients [with obesity] on 60% O2 with an SpO2 [blood oxygen level] of 93%. So, CPAP will have potential benefit to improve outcome, but the clinician needs to adjust the CPAP and the FiO2 to modify settings in line with the disease trajectory.”
Regardless, CPAP machines are one method of oxygen delivery and breathing assistance that healthcare professionals are using to care for people with COVID-19.
Creating simple, affordable options to help improve breathing
With increased cases of COVID-19 occurring and more people needing breathing assistance and supplemental oxygen, some researchers are focusing their efforts on creating simplified and more affordable alternatives to the existing respiratory aids.
The recent study and report from the University of Leeds, United Kingdom, reveal the efforts of a research team to develop an oxygen-efficient and low cost CPAP system. The researchers created a CPAP device that uses a single electric fan blower for use in situations where there is limited oxygen.
The device, the LeVe CPAP system, uses fewer parts than existing devices and is able to run on portable oxygen concentrators, a form of oxygen supply that is common in low income countries. The researchers tested its efficiency initially with a breathing simulator and found the device comparable to currently used CPAP machines.
Study author and professor of applied fluid mechanics, Nikil Kapur, explained to MNT that:
“The simplified CPAP system we have developed for [the] treatment of respiratory conditions, including COVID, can give very similar performance to more expensive counterparts, which then opens up access for resource-stretched hospitals. The system has also been designed with oxygen efficiency at the fore — many hospitals rely on oxygen concentrators where the output is not sufficient for other CPAP systems.”
The next step was to test using the device on healthy individuals to evaluate its effectiveness. The researchers’ primary objective was to see whether they could use the device without causing low oxygen levels or excessively high carbon dioxide levels in body tissues. They also wanted to see whether the device was tolerable for users.
This study took place at the intensive care unit at Mengo Hospital in Kampala, Uganda, with 10 members of the hospital staff, all of whom were healthy nonsmokers who did not have obesity. These participants also had no underlying respiratory problems or contraindications based on previous use of a CPAP machine or oxygen.
The team tested the device on four different settings, with oxygen saturation levels and carbon dioxide levels remaining within normal levels for all participants. All of the volunteers tolerated the device well. Based on these results, the researchers are prepared to move forward with testing in hospital patients.
When MNT asked Prof. Hart to comment on the study, he offered cautious advice. He expressed concern that this newly developed device needs to have a way to measure the concentration of oxygen (FiO2) and pressure of the CPAP to ensure effectiveness and prevent complications that can result from too low or too high a pressure. He told MNT:
“This is a simple device where oxygen is entrained and mixed with air delivered by a blower. The faster the blower speed, the higher the CPAP level delivered but the lower FiO2 delivered if the oxygen supply is fixed. Thus, this technology would benefit from an oxygen cell to measure FiO2 to measure the O2 concentration being delivered. In addition, a pressure manometer to measure pressure at the mask and the level of CPAP delivered would be required.”
With more testing still necessary, the researchers remain optimistic that this device could greatly help individuals with COVID-19 in areas with limited resources. Prof. Kapur told MNT, “We have undergone a healthy person trial and are about to start a patient study with Mengo hospital in Uganda — the team there have been instrumental in understanding how we can adapt this technique for treatment of COVID-19 patients in such resource-stretched settings.”
“Ultimately, we want to support local healthcare supply chains — so, if medical companies can use our designs to create self-sustaining industries in their own countries, that will benefit as many patients as possible.”
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