0
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
•Importan...
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
Assoc...
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...
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
• ...
Disadvantages of Using Active Humidifiers
During Mechanical Ventilation
• May develop condensation within the circuit
• Po...
Biological Hazards
• Biological hazards refer to biological substances
that pose a threat to the health of living
organism...
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 b...
51 May 2014
Absorption: Incorporation of moisture. This moisture
becomes a part of the media
Adsorption: Adhesion of moist...
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...
Inconsistent Therapy?
Passive humidifiers and inaccurate active humidification
settings may lead to undesirable sputum out...
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
199...
Trend of Humidity Delivered
HME
lowest
HMEF HCH HCHF
highest
76 May 2014
Respiratory Care; June 1999; Vol. 44 No. 6; Pg. 6...
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 (trac...
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 ...
May 201497
FOCUS Spring Conference - Presentation - Lecture - The Science of HMEs - May 2014
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Transcript of "FOCUS Spring Conference - Presentation - Lecture - The Science of HMEs - May 2014"

  1. 1. 1 May 2014
  2. 2. 2 May 2014
  3. 3. 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. 4. 4 May 2014 Inhalation Therapy
  5. 5. 5 Treatment for Respiratory Ailments Were Common During the Late 1800s February 2012
  6. 6. Compound Oxygen “Scientific adjustment to oxygen and nitrogen” Drs. Starkey and Palen, 1888 6 May 2014
  7. 7. 7 May 2014
  8. 8. 8 May 2014
  9. 9. 9 May 2014
  10. 10. 10 May 2014
  11. 11. The American Association of Inhalation Therapy The University of Chicago Hospital establishes the Inhalation Therapy Association in 1946 11 May 2014
  12. 12. 12 May 2014
  13. 13. An Early Oxygen Tank 13 May 2014
  14. 14. 14 May 2014
  15. 15. 15 What is 30/30? February 2012
  16. 16. 16 30/30 February 2012
  17. 17. 17 Active? Passive? Both? It is very important for respiratory therapists to evaluate each patient individually and choose the correct device. May 2014
  18. 18. Clinical Practice Guidelines During Mechanical Ventilation 18 May 2014
  19. 19. 19 November 2011
  20. 20. Advantages of Using Active Humidifiers During Mechanical Ventilation 20 May 2014
  21. 21. Advantages of Using Active Humidifiers During Mechanical Ventilation 21 May 2014
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. Secretions = Biological Hazard 25 May 2014
  26. 26. Heated Humidifiers 26 May 2014
  27. 27. May 201427
  28. 28. 28 May 2014
  29. 29. What is an Artificial Nose? 29 November 2011
  30. 30. The Artificial Nose 30 November 2011
  31. 31. The Artificial Nose 31 November 2011
  32. 32. 32 May 2014
  33. 33. Humidification During Mechanical Ventilation 33 May 2014
  34. 34. Humidification During Mechanical Ventilation 34 May 2014
  35. 35. Humidification During Mechanical Ventilation 35 May 2014
  36. 36. Humidification During Mechanical Ventilation 36 May 2014
  37. 37. Humidification During Mechanical Ventilation 37 May 2014
  38. 38. Advantages of Using Passive Humidifiers During Mechanical Ventilation 38 May 2014
  39. 39. Advantages of Using Passive Humidifiers During Mechanical Ventilation 39 May 2014
  40. 40. Disadvantages of Using Passive Humidifiers During Mechanical Ventilation 40 May 2014
  41. 41. Disadvantages of Using Passive Humidifiers During Mechanical Ventilation 41 May 2014
  42. 42. Disadvantages of Using Passive Humidifiers During Mechanical Ventilation 42 May 2014
  43. 43. Advantages of Using Active HME Humidifiers During Mechanical Ventilation 43 May 2014
  44. 44. Disadvantages of Using Active HME Humidifiers During Mechanical Ventilation 44 May 2014
  45. 45. All “Noses” Are Not Alike! 45 May 2014
  46. 46. 46 May 2014
  47. 47. 47 • heat and moisture exchanger HME • filter heat and moisture exchanger FHME May 2014
  48. 48. 48 • hygroscopic condensing humidifier HCH • filter hygroscopic condensing humidifier FHCH May 2014
  49. 49. 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. 50. 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. 51. 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
  52. 52. Coffee Pour Test 52 May 2014
  53. 53. Coffee Pour Test 53 May 2014
  54. 54. Examples of Passive and Active HMEs 54 May 2014
  55. 55. Examples of Passive Humidifier Designs 55 May 2014
  56. 56. Examples of Passive Humidifier Designs 56 May 2014 Many flex tubes will add about 2 mg of moisture
  57. 57. Examples of Trach Passive Humidifier Designs 57 May 2014
  58. 58. 58 May 2014
  59. 59. Examples of Humidification Media 59 May 2014
  60. 60. 60 May 2014
  61. 61. 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
  62. 62. 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
  63. 63. Don’t be Fooled, The 3Cs 64 May 2014
  64. 64. Don’t be Fooled, The 3Cs 65 May 2014
  65. 65. 66 May 2014
  66. 66. 67 May 2014
  67. 67. Don’t be Fooled, The 3Cs 68 May 2014
  68. 68. 69 May 2014
  69. 69. 70 May 2014
  70. 70. Don’t be Fooled, The 3Cs 71 May 2014
  71. 71. Collecting… 72 gas in May 2014 gas in gas out
  72. 72. Collecting… 73 May 2014
  73. 73. The 3Cs 74 May 2014
  74. 74. 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
  75. 75. Trend of Humidity Delivered HME lowest HMEF HCH HCHF highest 76 May 2014 Respiratory Care; June 1999; Vol. 44 No. 6; Pg. 636
  76. 76. Should PH be Chosen Based Upon Minute Ventilations? 77 May 2014
  77. 77. Is My Patient Being Humidified? 78 May 2014
  78. 78. 79 May 2014
  79. 79. 80 May 2014
  80. 80. Sputum Descriptions 81 May 2014
  81. 81. Assessment of Sputum Characteristics 82 May 2014
  82. 82. Research Independent Documentation of Effectiveness 83 May 2014
  83. 83. 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
  84. 84. MHRA & UK Medicines Healthcare Products 85 May 2014
  85. 85. 86 Richard Branson’s evaluation of 21 HMEs, Table 2. (Respir Care 1996; 41:736-743) May 2014
  86. 86. Documentation of PH Effectiveness 87 May 2014
  87. 87. MAUDE Adverse Event Report 88 May 2014
  88. 88. Early Coffee Cups 89 May 2014
  89. 89. Too Late to Check Effectiveness 90 May 2014
  90. 90. What to Look For When Choosing a PH 91 ??? May 2014
  91. 91. What to Look For When Choosing a PH 92 May 2014
  92. 92. What to Look For When Choosing a PH 93 May 2014
  93. 93. What to Look For When Choosing a PH 94 May 2014
  94. 94. What to Look For When Choosing a PH 95 May 2014
  95. 95. “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
  96. 96. May 201497
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