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Humidity Therapy

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Indications for humidity therapy Physiologic importance of humidity Types of humidifiers Humidifiers Add water vapor to inspired gas. Indications Make oxygen therapy ... – PowerPoint PPT presentation

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Title: Humidity Therapy


1
Humidity Therapy
  • Indications for humidity therapy
  • Physiologic importance of humidity
  • Types of humidifiers

2
Humidifiers
  • Add water vapor to inspired gas.
  • Indications
  • Make oxygen therapy more comfortable to upper
    airway
  • Prevent a humidity deficit if upper airway
    by-passed
  • Aerosol devices may also be used as humidifiers

3
Importance of Upper Airway
  • Filters ( particles down to 5 microns in
    diameter)
  • Vibrissae
  • Cilia (posterior 2/3 rds nasopharynx)
  • Warms
  • capillaries
  • Adds water vapor
  • mucus layer

4
Normally gas inspired through Upper Airway
  • 100 Relative Humidity at 33 o by the time gas
    reaches the carina
  • 100 Relative Humidity at 37 o at segmental
    bronchi

5
Isothermic saturation boundary
Irlbeck D. Normal mechanisms of heat and moisture
exchange in the respiratory tract. Respiratory
Care Clinics of North America. 1998 4(2) 189-198.
6
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7
Lower Airway
  • Not as efficient in humidifying inspired gases
  • 2 primary differences between upper and lower
    airways
  • Upper airway nasal capillaries have fenestrations
    like a soaker hose for the active transport of
    water.
  • Counter-current blood flow maintains gas
    temperature in the nasopharynx

8
Filtering by Lower Airway
  • Primary function of mucociliary escalator -
    called pulmonary clearance.
  • Mucociliary escalator two components
  • mucus
  • cilia

9
Mucus Layer
  • 2 layers
  • Sol or watery layer surrounds cilia
  • Gel or mucus layer rides on top
  • Mucus produced by submucosal glands and surface
    goblet cells.
  • SG outnumber GC 40 1 in trachea and bronchi
  • Fewer SG beyond level of bronchi
  • GC exist throughout respiratory tract
  • Mucus 95 water and 5 mucins (glycoproteins)

10
Cilia
  • Approximately 200 cilia per epithelial cell
  • Beat 1500/min
  • Move mucus blanket about 2 mm/min - takes about
    1 hour for mucus blanket to move from carina to
    pharynx
  • Ratio of ciliated cells to goblet cells 51

11
Mucociliary Escalator
  • Ends at terminal bronchioles
  • Alveoli cleared of foreign particles by alveolar
    macrophages

12
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13
If upper airway by-passed
  • Lower airway must filter, warm and humidify
    inspired gases
  • Mucociliary escalator is impaired
  • Sol layer dries out
  • Cilia unable to beat
  • Secretions arent cleared - airways blocked
  • Foreign particles (microbes) trapped on mucus
    blanket start to multiply

14
Types of Humidifiers
  • Unheated humidifiers
  • Bubble
  • Makes O2 Tx more comfortable to upper airway
  • Heated humidifers
  • Bubble/diffuser, wick, passover
  • Prevents humidity deficit if upper airway
    bypassed
  • Heat Moisture Exchangers (HME)

15
When to add Bubble Humidifier to Oxygen Delivery
Device
  • Oxygen from cylinder or wall outlet bone dry
  • Humidify oxygen from low flow devices if
  • nasal cannula gt 4 LPM
  • all low flow masks
  • High flow devices
  • Venti mask on higher FIO2 scale
  • APN and GIN are aerosol devices

http//www.rcjournal.com/online_resources/cpgs/ota
chcpg-update.html
16
Heated Humidifiers
  • Use when Upper Airway Passed
  • Endotracheal tube
  • Tracheostomy tube
  • Prevents humidity deficit

17
Humidity Deficit
  • 44 mg/L water vapor
  • inspired water vapor
  • humidity deficit (mg/L) at
  • 37 o C

18
With Artificial Airways (ETT and Tracheostomy
Tubes)
  • Upper airway bypassed
  • Lower Airway must make up humidity deficit
  • Causes mucosal drying and mucus plugging
  • Reason why humidifier must provide 100 RH at 32
    - 34 o C

19
Body Humidity 44 mg water vapor / Liter gas
  • 100 saturated with water vapor
  • 37o C

20
Relative Humidity
  • Actual water vapor Content
  • Capacity

21
Capacity of gas to hold water vapor determined by
gas temperature
Potential Humidity Table
  • Vapor Pressure

35
25
15
5
Temperature
22
What is the water vapor content of 50 RH at 20o
C?
23
50 RH at 20o C
  • Capacity 20o C 17.30 mg/L
  • Content .50
  • 17.30
  • 17.30 x .5 8.65 mg/L

24
What is the Body Humidity?
  • Inspired gas contains 8.65 mg/L water vapor
  • Body Humidity ?

25
Body Humidity
  • content / 44 mg/L BH
  • 8.65 20 body humidity

44
26
If Upper Airway Bypassed
  • Heated Humidifier
  • Inspired gas temperature at mouth 32 - 34o C

27
Humidifiers Increase the Rate of Evaporation
28
Evaporation
  • Define
  • Requires energy in the form of heat.
  • Latent heat of evaporation

Co
steam
539 cal
100
Vaporizing
water
Melting
0
ice
calories
744
205
105
25
Heat added
29
Factors that Increase the Rate of Evaporation
  • Increased surface area of gas/liquid interface
  • Decreased surface vapor pressure
  • Agitation
  • Heat

30
Humidifiers
  • Unheated
  • Bubble
  • Heated
  • Bubble/diffuser
  • Passover
  • Wick
  • HME

31
Bubble Humidifier
32
Passover Humidifier
33
Wick Humidifier (Concha-Pak)
GAS
heater
wick
H2O
H2O
34
RCI Concha Pak
35
Fisher-Paykel MR 390
36
Wick Humidifier (Fisher-Paykel)
37
Vapotherm 2000i
  • Heated humidifier
  • Wick-like (hollow gas filled fibers surrounded by
    heated water)
  • Humidifies flow rates up to 40 LPM via nasal
    cannula or 20 LPM via trans-tracheal cannula
  • Flows 5 40 LPM adult and 1 8 LPM neonatal
  • 33-43o C output temperature

38
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39
  • Vapor transfer cartridge
  • Hundreds of hollow fibers filled with gas
    surrounded by heated water
  • Voluntary Recall in 2005 FDA recall 2006.
    Ralstonia species of bacteria.  Ralstonia, as
    with any gram negative organism, may cause
    infection, sepsis and in most severe cases be
    life threatening.

40
HME - Heat Moisture Exchangers
  • Use when upper airway by-passed
  • Made of material that traps patients own heat
    and moisture from an exhaled breath. (50
    efficient)
  • Also called Artificial Noses
  • HCH - Hygroscopic Condenser Humidifiers -
    superior to sponge-like material of HMEs. (70
    efficient)

41
HMEs or HMEFs (HME Filters
  • Not for patients with
  • thick or bloody secretions
  • core temperatures lt 32 o C
  • Expired VT lt 75 of inspired VT
  • VE gt 10 L/min

42
Thermax HC Humidifier (HCH)
  • The Thermax HCH combines chemically reactive
    Sodasorb and a conventional HME/HCH.
  • The exothermic chemical reaction of converting
    expired carbon dioxide to calcium carbonate and
    water actively heats and provides moisture
  • Exhaled carbon dioxide reacts with the Sodasorb
    to produce heat and moisture.
  • Unlike a conventional, passive HME/HCH, inhaled
    moisture content and temperature are higher than
    exhaled moisture and temperature.
  • One possible benefit of this active HME/HCH
    device is in hypothermic patients, in whom warm,
    humidified inhaled gases can help raise reduced
    body temperature.
  • 79 mL deadspace compared to 10 mL from Gibeck

Broach, SD CG Durbin. A randomized, controlled,
clinical trial of a chemically-reactive heated
humidifier. RC. 2001 46 (1), 37-42.
43
Inside Thermax HCH
http//www.enternetmedical.com/prod04.htm
44
Thermax Hygroscopic Condenser
Sodasorb
sponge
http//www.enternetmedical.com/Anesthermax.jpg
45
Summary
  • Unheated humidifiers
  • Make gas therapy more comfortable
  • Bubble humidifiers
  • Heated humidifiers
  • Prevent humidity deficit
  • Passover and wick humidifiers
  • HME/HCH/heated HCH
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