Transcript As for content, what I am looking for in your presentation are: Review

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The birth of respiratory care
The AARC Clinical Practical Guidelines
The artificial nose
May 2014
The Artificial Nose:
How does it function
 The 6 types of passive humidifiers
 Design
 The 3 Cs
 Moisture media
 Important features
 Documentation of effectiveness
 What to look for when choosing a passive
humidifier
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May 2014
Inhalation Therapy
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Compound Oxygen
“Scientific adjustment to oxygen and nitrogen”
Drs. Starkey and Palen, 1888
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Active? Passive? Both?
It is very important for respiratory therapists to evaluate each patient
individually and choose the correct device.
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May 2014
Clinical Practice Guidelines
During Mechanical Ventilation
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May 2014
Heated Humidifiers
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Humidification During Mechanical Ventilation
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Humidification During Mechanical Ventilation
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Humidification During Mechanical Ventilation
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May 2014
Humidification During Mechanical Ventilation
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May 2014
Humidification During Mechanical Ventilation
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May 2014
Advantages of Using Passive Humidifiers
During Mechanical Ventilation
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May 2014
Disadvantages of Using Passive Humidifiers
During Mechanical Ventilation
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May 2014
Disadvantages of Using Passive Humidifiers
During Mechanical Ventilation
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May 2014
Advantages of Using Active HCH Humidifiers
During Mechanical Ventilation
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May 2014
Disadvantages of Using Active HME Humidifiers
During Mechanical Ventilation
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May 2014
All “Noses” Are Not Alike!
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May 2014
HME
• heat and moisture exchanger
FHME
• filter heat and moisture exchanger
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HCH
• hygroscopic condensing humidifier
FHCH
• filter hygroscopic condensing
humidifier
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Bypass HME
• gas flow may be redirected to and
around the media
Active HME
• heat and water added to the HME
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May 2014
Examples of Passive and Active HMEs
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Examples of Passive Humidifier Designs
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Examples of Humidification Media
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May 2014
Humidification for Patients with Artificial Airways
Examine patient’s
Hx/Px
Bloody secretions?
Thick tenacious sputum?
Less than 70%?
Core temp less 320 C?
NO
RESPIRATORY CARE; JUNE 1999; VOLUME: 44 NO 6; page 638
YES
Use heated
humidification
Replaced HME
q 24 hrs?
Evaluate secretion
quality and quantity
Examine patient
More than 4 HMEs
used in 24 hours?
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NO
YES
May 2014
Inconsistent Therapy?
Passive humidifiers and inaccurate active humidification
settings may lead to undesirable sputum outcomes,
endotracheal tube occlusions and/or pneumothorax.
RRT replaces HME and perceives everything to be ok
Don’t be Fooled, The 3Cs
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Collecting
gas in
gas in
gas out
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May 2014
Coffee Pour Test
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May 2014
Most Important Features of PH
Filter?
Design?
Cost?
Dead
space?
Resistance?
Moisture
output?
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Respiratory Care; June
1999; Vol. 44 No. 6; Pg. 636
May 2014
Trend of Humidity Delivered
HME
lowest
HMEF
HCH
HCHF
highest
Respiratory Care; June 1999; Vol. 44 No. 6; Pg. 636
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Should PH be Chosen Based
Upon Minute Ventilations?
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Is My Patient Being Humidified?
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Is My Patient Being Humidified?
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Assessment of Sputum Characteristics
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Secretions Trend
Clear
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White
Yellow Green
Cream Brown
May 2014
Research Independent Documentation
of Effectiveness
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May 2014
This patient was featured on The Learning Channel.
2nd and 3rd degree burns over 60% of the body
and 3 months LOS (tracheal not comprised)
Only this product was used to humidify the patient.
Used with permission
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May 2014
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MHRA - Medicines and Healthcare Products Regulatory
Agency & UK Medicines Healthcare Products
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Richard Branson’s evaluation of 21 HMEs, Table 2.
(Respir Care 1996; 41:736-743)
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Documentation of PH Effectiveness
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An Example - MAUDE Adverse Event Report
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Too Late to Check Effectiveness
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Early Sputum Collection Cups
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May 2014
Early Coffee Cups
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What to Look For When Choosing a PH
???
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May 2014
What to Look For When Choosing a PH
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What to Look For When Choosing a PH
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What to Look For When Choosing a PH
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What to Look For When Choosing a PH
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“Our findings suggest that the initial application of an
extended-use hygroscopic condenser humidifier is a safe
and more cost-effective method of providing humidification
to patients requiring mechanical ventilation compared with
heated-water humidification.”
Chest. 1998 Mar; 113(3): 759-67.
A randomized clinical trial comparing an extended-use hygroscopic condenser humidifier
with heated-water humidification in mechanically ventilated patients.
Kollef MH, Shapiro SD, Boyd V, Silver P, Von Harz B, Trovillion E, Prentice D.
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