FOCUS Spring Conference - Presentation - Lecture - The Science of HMEs - May 2014
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FOCUS Spring Conference - Presentation - Lecture - The Science of HMEs - May 2014

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FOCUS Spring Conference - Presentation - Lecture - The Science of HMEs - May 2014 FOCUS Spring Conference - Presentation - Lecture - The Science of HMEs - May 2014 Presentation Transcript

  • 1 May 2014
  • 2 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. 3 May 2014
  • 4 May 2014 Inhalation Therapy
  • 5 Treatment for Respiratory Ailments Were Common During the Late 1800s February 2012
  • Compound Oxygen “Scientific adjustment to oxygen and nitrogen” Drs. Starkey and Palen, 1888 6 May 2014
  • 7 May 2014
  • 8 May 2014
  • 9 May 2014
  • 10 May 2014
  • The American Association of Inhalation Therapy The University of Chicago Hospital establishes the Inhalation Therapy Association in 1946 11 May 2014
  • 12 May 2014
  • An Early Oxygen Tank 13 May 2014
  • 14 May 2014
  • 15 What is 30/30? February 2012
  • 16 30/30 February 2012
  • 17 Active? Passive? Both? It is very important for respiratory therapists to evaluate each patient individually and choose the correct device. May 2014
  • Clinical Practice Guidelines During Mechanical Ventilation 18 May 2014
  • 19 November 2011
  • Advantages of Using Active Humidifiers During Mechanical Ventilation 20 May 2014
  • Advantages of Using Active Humidifiers During Mechanical Ventilation 21 May 2014
  • Disadvantages of Using Active Humidifiers During Mechanical Ventilation • Temperature setting is not humidity delivered • Costly, possibilities of malfunction and down time • Use problems as reported in MAUDE – Manufacture and User Facility Device Experience 22 May 2014
  • Disadvantages of Using Active Humidifiers During Mechanical Ventilation • May develop condensation within the circuit • Possible infectious waste (biological hazard) drainage into heater reservoir, the ventilator and more • Complex to use with over or under hydration possible • May not produce as much humidity as thought. 23 May 2014
  • Biological Hazards • Biological hazards refer to biological substances that pose a threat to the health of living organisms, primarily that of humans. • The term and associated symbol are generally used as a warning, so that those potentially exposed to the substance will know to take precautions. From Wikipedia, the free encyclopedia 24 May 2014
  • Secretions = Biological Hazard 25 May 2014
  • Heated Humidifiers 26 May 2014
  • May 201427
  • 28 May 2014
  • What is an Artificial Nose? 29 November 2011
  • The Artificial Nose 30 November 2011
  • The Artificial Nose 31 November 2011
  • 32 May 2014
  • Humidification During Mechanical Ventilation 33 May 2014
  • Humidification During Mechanical Ventilation 34 May 2014
  • Humidification During Mechanical Ventilation 35 May 2014
  • Humidification During Mechanical Ventilation 36 May 2014
  • Humidification During Mechanical Ventilation 37 May 2014
  • Advantages of Using Passive Humidifiers During Mechanical Ventilation 38 May 2014
  • Advantages of Using Passive Humidifiers During Mechanical Ventilation 39 May 2014
  • Disadvantages of Using Passive Humidifiers During Mechanical Ventilation 40 May 2014
  • Disadvantages of Using Passive Humidifiers During Mechanical Ventilation 41 May 2014
  • Disadvantages of Using Passive Humidifiers During Mechanical Ventilation 42 May 2014
  • Advantages of Using Active HME Humidifiers During Mechanical Ventilation 43 May 2014
  • Disadvantages of Using Active HME Humidifiers During Mechanical Ventilation 44 May 2014
  • All “Noses” Are Not Alike! 45 May 2014
  • 46 May 2014
  • 47 • heat and moisture exchanger HME • filter heat and moisture exchanger FHME May 2014
  • 48 • hygroscopic condensing humidifier HCH • filter hygroscopic condensing humidifier FHCH May 2014
  • 49 • gas flow may be redirected to and around the media Bypass HME • heat and water added to the HME Active HME May 2014
  • 50 May 2014 Hygroscopic: The ability of a substance to attract and hold water molecules from the surrounding environment by enhancing the natural physical properties. This is achieved through either absorption or adsorption with the absorbing or adsorbing material becoming physically "changed.”
  • 51 May 2014 Absorption: Incorporation of moisture. This moisture becomes a part of the media Adsorption: Adhesion of moisture to a surface Adsorption is a surface-based process while absorption involves the whole volume of the material
  • Coffee Pour Test 52 May 2014
  • Coffee Pour Test 53 May 2014
  • Examples of Passive and Active HMEs 54 May 2014
  • Examples of Passive Humidifier Designs 55 May 2014
  • Examples of Passive Humidifier Designs 56 May 2014 Many flex tubes will add about 2 mg of moisture
  • Examples of Trach Passive Humidifier Designs 57 May 2014
  • 58 May 2014
  • Examples of Humidification Media 59 May 2014
  • 60 May 2014
  • Replaced HME q 24 hours Bloody secretions? Thick tenacious sputum? Less than 70%? Core temp less 320 C? Evaluate secretion quality and quantity Examine patient Use heated humidification Examine patient’s Hx/Px More than 4 HMEs used in 24 hours? NO YES YES NO May 201461 Humidification for Patients with Artificial Airways RESPIRATORY CARE; JUNE 1999; VOLUME: 44 NO 6; page 638
  • 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 64 May 2014
  • Don’t be Fooled, The 3Cs 65 May 2014
  • 66 May 2014
  • 67 May 2014
  • Don’t be Fooled, The 3Cs 68 May 2014
  • 69 May 2014
  • 70 May 2014
  • Don’t be Fooled, The 3Cs 71 May 2014
  • Collecting… 72 gas in May 2014 gas in gas out
  • Collecting… 73 May 2014
  • The 3Cs 74 May 2014
  • Most Important Features of PH 75 Filter? Cost? Resistance? Moisture output? Dead space? Design? Respiratory Care; June 1999; Vol. 44 No. 6; Pg. 636 May 2014
  • Trend of Humidity Delivered HME lowest HMEF HCH HCHF highest 76 May 2014 Respiratory Care; June 1999; Vol. 44 No. 6; Pg. 636
  • Should PH be Chosen Based Upon Minute Ventilations? 77 May 2014
  • Is My Patient Being Humidified? 78 May 2014
  • 79 May 2014
  • 80 May 2014
  • Sputum Descriptions 81 May 2014
  • Assessment of Sputum Characteristics 82 May 2014
  • Research Independent Documentation of Effectiveness 83 May 2014
  • 84 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 May 2014
  • MHRA & UK Medicines Healthcare Products 85 May 2014
  • 86 Richard Branson’s evaluation of 21 HMEs, Table 2. (Respir Care 1996; 41:736-743) May 2014
  • Documentation of PH Effectiveness 87 May 2014
  • MAUDE Adverse Event Report 88 May 2014
  • Early Coffee Cups 89 May 2014
  • Too Late to Check Effectiveness 90 May 2014
  • What to Look For When Choosing a PH 91 ??? May 2014
  • What to Look For When Choosing a PH 92 May 2014
  • What to Look For When Choosing a PH 93 May 2014
  • What to Look For When Choosing a PH 94 May 2014
  • What to Look For When Choosing a PH 95 May 2014
  • “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. 96 May 2014
  • May 201497