As a critical shortage of ventilators looms, New York Governor Andre Cuomo revealed Friday that the state will begin repurposing BiPAP machines to sustain severely ill coronavirus patients.
Last week, the state resorted to converting anesthesia machines to supplement its stockpile of an estimated 6,500 ventilators.
Thursday, Cuomo said he wasn’t sure if BiPAP machines could or would be used as ventilators, but by Friday the state had included them in the list of alternatives it was pursuing.
WHAT IS A BIPAP MACHINE?
BiPAP is an acronym for bilevel positive airway pressure. These and continuous positive airway pressure (CPAP) machines are used to treat patients with sleep apnea.
People with sleep apnea may stop breathing during while asleep for a number of reasons, and the machine ensures they continue to have normal respiration.
One of the machine’s positive pressure airways helps to push air into the lungs while a second is set to a lower pressure that makes it easier for a patient to breathe out normally.
The alternation of these two components is set to match the patient’s normal inhalation and exhalation pattern, which makes it feel more comfortable and similar to natural breathing when in use.
Pressure is delivered through a tube connected to a face mask that’s worn at night.
HOW IS A BIPAP MACHIE DIFFERENT FROM A VENTILATOR?
Ventilators are typically reserved for only the sickest patients who may not be able to breathe on their own at all, as opposed to sleep apnea patients, whose breathing is abruptly interrupted periodically, but whose lungs are generally functional.
So-called mechanical ventilation is both more invasive and more forceful than a BiPap.
Patients on ventilators are intubated, meaning a tube is threaded through the mouth and airway and the machine creates the contraction and expansion action their lungs are no longer able to do on their own.
They can, however, be used less invasively, with a mask like patients on BiPAP machines use.
HOW CAN A BIPAP MACHINE BE USED AS A VENTILATOR?
Both machines broadly help the lungs when they’re struggling to function.
For one, the settings have to be adjusted to not just augment the patient’s inhalations and exhalations, but to do the work for them.
To convert BiPAPs, which are typically used with masks, to be used on intubated patients, scientists at Northwell Health in New York City 3-D printed a T-shaped adapter.
Their method has been tested successfully on dozens of patients.
At the University of California, Berkeley, team reconfigured a BiPAP machine so that it can take in oxygen from a tank, rather than just drawing on the air around it.
Endotracheal tubes that go down the windpipe were then attached in addition to a double-filtering system to ensure that pathogens like the coronavirus don’t get in or out.
Already, the FDA has cleared the way for sleep apnea machines like these to be used as ventilators, a previously unapproved use for BiPAP or similar CPAP machines.
