1430: Chapter 35 Humidity and Bland Aerosol Therapy

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What is the Isothermic saturation boundary and where is is located?
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What is the Isothermic saturation boundary and where is is located?
Where inspired gas achieves BTPS conditions(Body Temp 37C; barometric pressure; saturated with water vapor[100%].
It is located 5cm below the carina. It can shift due to inspiration and exhalation temp variations.
Humidifier
Device that adds molecular water to gas. Occurs by evaporation of water from a surface. Can be in a reservoir, a wick, or a sphere of water in suspension(aerosol)
Bubble-Diffusion
technique that directs a stream of gas underwater, where it is broken up into small bubbles. As the gas bubbles rise to the surface, evaporation increases the water vapor content within the bubble. The smaller the bubble, the greater the water/air surface-area ratio.
4 variables that affect the quality of humidifier performance
Temp
Surface area
time of contact
thermal mass
types of humidifiers(Active)- Adds heat to water
bubble
passover
nebulizers
vaporizers
types of humidifiers(Passive)- Recycles the air.
Heat and Moisture exchangers(HMEs)
Ideal HME specs:
70% efficiency
30 mg/L water vapor
Where should you place the thermistat probe?
In the inspiratory limb of a ventilator circuit far away from the patient 'wye' to ensure that warm exhaled gas does not fool the controller system. Never place a probe in an isolette or a radiant warmer, where the probe is warmed externally and the humidifier is fooled into shutting down, reducing the humidity available to the patient.
How should you treat circuit condensate?
Always as infectious waste. Wear gloves and goggles. Always drain the tubing away from the patients airway into an infectious waste container, and dispose of the waste according to the policies and procedures of the institution.
How can you confirm that the HME is working by looking at the tubing?
Visually confirming condensate in the flex tube between the airway and the HME. Lack of condensate may be a clue that humidification is inadequate and that alternative systems may be appropriate for use with the patient.
Trouble shooting the proper conditioning of inspired gas
Adjust temp to a point that a few drops of condensate is formed at the 'wye'(vapor trail)
hygrometermost reliable and accurate to ensure expected temperature and humidity level.What does the HME do? They can be active and passive.Recreates the work of the upper airwayWhat is the primary goal of the humidification?To maintain normal physiological conditions in the lower airways.What is the primary indication for a humidifier?Humidifying dry medical gases, overcoming humidity deficit created when upper airway is bypassed.What are the secondary indications for humidification?Managing hypothermia Treating bronchospasm caused by cold air.Med gas administration, upper airway bypassed, no airway leak, no thick/bloody secretions, no high minute volumeHME- If there is not an upper airway bypass then NO humidification required at flow <4L/m, with jet mixing at <50% or with short term mask therapy. If there is an airway leak, thick/bloody secretions, and a high minute volume use Heated humidifierHypothermiaHeated aerosol or humidifierCold air reactive airwayheated humidifier(no aerosols)Thick secretionsProvide systemic hydration. If there is a humidity deficit then add humidity to match airway conditions.If there isn't a deficit then no humidity is needed.3 passover typessimple reservoir, wick, and membrane.%50 percent relative humidity at nose and mouthGases delivered to the nose and mouth should be conditioned to 20-22C with 10mg/L water vapor(50%RH)Trachea delivery temps and RH32-40C with 36-40 mg/L(>90RH)A humidifier does what with molecules?It is a device that adds invisible molecular water to gas.A nebulizer does what?It generates and disperses liquid particles in a gas stream.Active humidifiers incorporate what?They incorporate heating devices and reservoir and feed systems.common problems with humidification systemsCondensation, cross contamination, and ensuring proper conditioning of the inspired gas.What is bland aerosol therapy with sterile water or saline used to treat?Upper airway edema overcome heat and humidity deficits in patients with tracheal airways help obtain sputum specimens.Common problems with bland aerosol therapycross contamination infection environmental safety inadequate mist production over hydration brochospasm noiseAirway appliances for bland aerosolAerosol Mask, Face Tent Trach mask, T-TubeTypes of heating systemshot plate elements wrap-around type that surrounds the humidifier chamber yolk that sits in between the water reservoir and the gas outlet immersion-type heater with element placed in the water reservoir heated wire in the inspiratory limb warming a saturated wick or hollow fiber thin-film, high surface broilerWhat causes rain out?As gas cools, it water vapor capacity decreases causing condensate.IndicationsWhenever an endotrachael or trach is presentContraindicationsthick copius bloody secrections expired tidal volume less than 70% of the delivered tidal volume temp is less than 32C high spontaneous minute volumes >10L/min in line drug treatmentscan you provide o2 therapy with large volume jet nebulizerYesProblems with little kids?CO2 build up and heat retentionSputum sample specificationsWith high density hypertonic saline solution(3to10%)How to ajust particle size on a UN?increase or decrease amplitude.