This document provides information about humidification for respiratory therapy. It defines humidification as moisturizing air or gases breathed in to replace the normal humidifying function of the upper respiratory tract. When the upper airway is bypassed, humidification becomes necessary to prevent drying of the airways. The document describes different types of humidifiers including ambient temperature vapor suppliers, heated vapor suppliers, and ambient aerosol suppliers. It provides indications for humidification such as intubation or thick secretions. Contraindications include low body temperature or large air leaks. The document helps explain best practices for selecting the appropriate humidification method.

1. HUMIDIFICATION
DR.KRISHNA GOHIL (PT)

2. CONTENT
• INTRODUCTION
• DEFINITION
• WHAT IS THE REQUERMENT OF IT?
• HOW DOES IT WORK?
• TYPES
• METHODS
• INDICATIONS
• CONTRAINDICATION

3. INTRODUCTION
•IN OUR UPPER
RESPIRATORY SYSTEM
THE NOSE HAS A
NUMBER OF
IMPORTANT
FUNCTIONS
INCLUDING
WARMING,
HUMIDIFYING AND

4. INTRODUCTION
• THE HIGH FLOW RATES DELIVERED BY NON
INVASIVE VENTILATION CAN PRODUCE DRYING OF
THE AIRWAY, THIS CAN LEAD TO CHANGES IN
CILIARY ACTIVITY, MUCOUS SECRETION AND
INCREASE NASAL RESISTANCE.
• HUMIDIFICATION IS MANDATORY WHILE PATIENT
UNABLE TO BREATH BY THEIR ORIGINAL
AIRWAY(UPPER RESPIRATORY) AND ITS DONE
THROUGH ANOTHER WAY:
• BREATH FROM MOUTH
• ENDOTRACHEAL ROUTE

5. DEFINITION
• HUMIDIFICATION :
• MOISTURIZING OF THE AIR OR GASES WE BREATHE. THIS IS
NORMALLY ONE OF THE FUNCTIONS OF THE UPPER
RESPIRATORY TRACT.1
OR
HUMIDITY THERAPY INVOLVES ADDING WATER VAPOR AND
(SOMETIMES) HEAT TO THE INSPIRED GAS.2
1. Patricia A. Downie, Cash’s textbook of chest, heart and vascular disorders for physiotherapists,
4th edition.
2. Robert M. Kacmarek, James K. Stoller, Albert J. Heuer, Egan’s fundamentals of respiratory care,
12th edition.

6. • HUMIDITY IS WATER IN ITS GASEOUS OR MOLECULAR FORM
AND ITS QUANTITY DEPENDS ON THE TEMPERATURE OF THE
GAS AND IS EXPRESSED AS ABSOLUTE HUMIDITY (AH) AND
RELATIVE HUMIDITY (RH).
• AH : THE AMOUNT OF WATER IN A GIVEN VOLUME OF GAS,
IS USUALLY EXPRESSED IN MILLIGRAMS PER LITER (MG/L).
• RH : THE AMOUNT OF WATER VAPOR IN A VOLUME OF GAS,
IS EXPRESSED AS A PERCENTAGE OF THE AMOUNT OF WATER
VAPOR REQUIRED TO FULLY SATURATE THAT GAS AT THE
SAME TEMPERATURE AND PRESSURE.

8. HOW IS IT WORK..?
• DURING MECHANICAL VENTILATION UPPER AIRWAY IS
BYPASSED BY THE ETT OR TRACHEOSTOMY TUBE OR WHILE
FACE MASK (DRY GASES) AND REST OF THE AIRWAY NOT
ABLE TO PROVIDE ENOUGH MOISTURE AND HEAT TO THE
DELIVERED GASES.
• AND THAT ARE THE DRY AND COLDER THEN BODY
TEMPERATURE.
• HUMIDIFICATION AND HEATING IS ESSENTIAL TO AVOID
COMPLICATIONS SUCH AS HYPOTHERMIA, THICKNESS OF
AIRWAY SECRETIONS, DESTRUCTION OF AIRWAY
EPITHELIUM AND ATELECTASIS.

9. • HUMIDIFIER THAT OPERATES TO INCREASE THE
HEAT AND WATER VAPOUR CONTENT OF THE GASES
IS INTERPOSED IN THE INSPIRATORY LIMB OF THE
VENTILATOR CIRCUIT AND THE TEMPERATURE IS
USUALLY SET TO DELIVER APPROXIMATELY 37̊C TO
THE DISTAL AREA OF THE CIRCUIT.

10. METHOD
• HUMIDIFICATION IS EFFECTIVELY DELIVERED TO
THE PATIENT ONLY BY WIDE BORE TUBING
(NARROW – CONDENSATION, IT’LL OCCUR
BLOCK).

11. METHODS
OF
HUMIDIFICATION
FREE
BREATHING
MECHANICAL
VENTILATION
IPPV
NOT
INTUBATED
WITH
TRACHEASTOMY
TUBE
FACE MASK
MOUTH PIECE
TRACHEASTOMY
HUMIDIFING T-TUBE
TRACHEASTOMY
MASK

12. FACE
MASK
• TEMPERATURE
MAINTAIN BY
MECHANICAL
SETUP.
• COVER THE
WHOLE MOUTH
AND NOSE.

13. MOUTH
PIECE
• PATIENT HAS TO HOLD
IT.
• USED WITH NEBULIZER AS
A METHOD OF GIVING
SHORT PERIOD OF
HUMIDIFICATION BEFORE
CHEST CLEARANCE.

14. TRACHEOST
OMY MASK
• NOW USUALLY
DISPOSABLE
• MADE UP
FROM FLEXIBLE
AND RIGID
PLASTICS.
•BUT NOT
MOSTLY USED
FLEXIBLE
PLASTIC.

15. TRACHEOSTO
MY
HUMIDIFYING
T-TUBE
• BROMPTON TUBE
•MADE UP FROM
PLASTIC.
• DIRECTLY FIT ON
THE WIDE BORE
TUBING AND THE
TRACHEOSTOMY.
• ALSO USED IN
PATIENT WITH AN
ENDOTRACHEAL

16. IPPV
• A PATIENT ON INTERMITTENT POSITIVE PRESSURE
VENTILATION.
• ITS ESSENTIAL THAT PATIENT RECEIVE THE
HUMIDIFICATION WHICH ON IPPV.
• THE IDEAL TEMPERATURE OF ENDOTRACHEAL TUBE
AND TRACHEOSTOMY ENTRANCE SHOULD BE 34̊ C ±
2̊ C AND THAT’S THE MAINTAIN BY HUMIDIFIER.

17. TYPES OF HUMIDIFIER
• CLASSIFIED BY BOYS AND HOWELLS (1972)
• SUPPLIERS AND CONSERVERS OF WATER
• THEN SUBDIVIDE INTO FORMER GROUP
• SUPPLIERS
• AMBIENT TEMPERATURE VAPOUR SUPPLIERS
• HEATED VAPOUR SUPPLIERS
• AMBIENT AERO

18. AMBIENT TEMPERATURE VAPOUR
SUPPLIERS
ITS ALSO CALLED BUBBLE HUMIDIFIER.
IT CONSIST OF A BOTTLE OR RESERVOIR PARTIALLY FILLED WITH WATER
ATTACHED TO A CONDUCTION SYSTEM THAT FILLED WITH WATER ATTACHED TO
A CONDUCTION SYSTEM THAT ALLOWS THE INSPIRED MEDICAL GASES TO BE
INTRODUCED BELOW THE WATER SURFACE.
A DIFFUSER THAT IS USUALLY EITHER A FORM OR A METALLIC MESH IS ATTACH
TO THE END OF THE CONDUCTION SYSTEM.

19. • INDICATION: IT IS USED TO HUMIDIFY THE INSPIRED
MEDICAL GASES DELIVERED TO PATIENT VIA A CANNULA
OR FACE MASK.
• CONTRAINDICATION: PATIENT WITH ENDOTRACHEAL TUBE,
A TRACHEOSTOMY OR TENACIOUS SECRETIONS.
• HAZARD: WHENEVER HIGH RATES ARE USED, BUBBLE
HUMIDIFIERS CAN PRODUCE AEROSOLS. THESE WATER
DROPLETS CAN TRANSMIT PATHOGENIC BACTERIA FROM
THE HUMIDIFIER RESERVOIR TO THE PATIENT.

20. HEATED VAPOUR SUPPLIERS
GAS IS PASSED THROUGH HOT WATER.
MAY BE DRIPPED ONTO A VERY HOT PLATE
THE PATIENT TUBING MAY BE LAGGED OR HEATED
TO PREVENT TEMPERATURE LOSS AND ‘RAIN OUT’
DEVICE HAS NO MORE CAPACITY THEN 39̊C
SO THERE IS NO DANGER OF BURN

21. • INDICATION: IT PROVIDE A
HIGH LEVEL OF HUMIDITY
AND HEAT, AND FOR THAT
REASON ARE MAINLY USED IN
INTUBATED AND VENTILATED
PATIENTS.
• HAZARD: RISK OF ELECTRICAL
SHOCK
• IF THE TEMP. IS NOT
ADEQUATELY SET, IT CAN
RESULTS IN HYPO OR
HYPERTHERMIA AND
THERMAL INJURY OF AIRWAY.

22. AMBIENT AEROSOL SUPPLIERS
FOR PRODUCE THE MIST OF LIQUID WATER
• BREAKING UP WATER RHYTHM BY HIGH PRESSURE
GAS JET ON ANVIL
OR
• GENERATING MIST WITH HIGH SPEED SPINNING
DISC / ULTRASONIC VIBRATING CRYSTAL.

25. AMBIENT AEROSOL SUPPLIERS
• MANY OF THESE DEVICES ARE OXYGEN OPERATED
AND MANAGING ROOM AIR IN VARYING AMOUNT
ACCORDING TO THE OXYGEN PERCENTAGE
REQUIRED.
• TOTAL GAS FLOW VARIES WITH THE PATTERN
AND ITS BECOME MORE NOISY WHEN LOW O2
CONCENTRATIONS ARE USED.

26. • INDICATION: LARGE VOLUME JET NEBULIZER.
• UPPER AIRWAY OEDEMA, SUBGLOTTIC OEDEMA.
• WHENEVER NEED OF MOBILIZATION OF SECRETIONS AND
SPUTUM SPECIMEN.
• CONTRAINDICATION: HISTORY OF UPPER AIRWAY
HYPERRESPONSIVENESS AND RISK OF
BRONCHORESTRICTION.

27. HEATED AEROSOL SUPPLIERS
• THE WATER SHOULD BE HEATED
• IN PARTICULAR THE BERNOULLI TYPE DEVICES ARE
OFTEN MADE TO TAKE A HEATING ELEMENT OR ‘ HOT
ROD’.
• THERMAL SAFETY IS ESSENTIAL.
WATER MAY BE SIMPLY ADDED TO THE AIRWAY BY
DIRECT INSTILLATION FROM A SYRINGE, DRIP SET OR
PUMP.

28. CONSERVERS
HEAT AND MOISTURE EXCHANGERS (HMES)
• ALSO CALLED CONDENSER HUMIDIFIERS.
• TRAP EXPIRED HEAT AND WATER IN A MESH
RETURN IT TO IN FRESH INSPIRED GAS.
• PRONE TO BLOCKAGE BY SECRETIONS.
• EXAMPLES : PORTEX, SIMEMENS, ENGSTORM.

29. CONSERVERS

30. CHOICE OF HUMIDIFIER
HUMIDIFIERS TO BE CHOOSE:
WHEN SECRETIONS ARE ALREADY THICK, DROPLET
HUMIDITY IS BETTER AT LOOSENING THEN THE
VAPOUR.
• ULTRASONIC ARE THE BEST FOR THIS PURPOSE.
• ITS ALSO IRRITANT AND PROMOTE COUGHING.
KENDALL MODEL CAN BE PERSUADED TO DO SO
WITH SOME DIFFICULTY.
VENTURI DEVICES.

31. CHOICE OF HUMIDIFIER
NOT TO BE CHOOSE:
COLD DROPLETS : ITS CAUSE BRONCHOCONSTRICTION AND ITS UNSUITABLE FOR
• ASTHMATICS
• CHRONIC OBSTRUCTIVE AIRWAY DISEASE
• SOME FORM OF HEART DISEASE : MITRAL VALVE DISEASE
ITS ALSO CAUSE HYPOTHERMIA : WATER DEPOSITED IN THE
AIRWAY USES BODY HEAT IN ORDER TO VAPOURISE.
ULTRASONICS MAY CAUSE A WATER OVERLOAD IN A
SUSCEPTIBLE PATIENT AND SHOULD PROBABLY BE AVOIDED
ALTOGETHER IN CHILDREN.

32. CHOICE OF HUMIDIFIER
 TOTALLY DISPOSABLE HUMIDIFIERS ARE CONVENIENT AND
CLEAN, BUT AT PRESENT THERE IS NO MODEL AVAILABLE
WHICH CAN CONVENIENTLY DELIVER LESS THAN 28% OXYGEN
TOGETHER WITH WARM HUMIDITY.
 IT IS NEEDED FOR:
• RESPIRATORY FAILURE
• CHRONIC BRONCHITIS
• ASTHMA
• EMPHYSEMA

33. INDICATIONS
• WHEN BREATHING THROUGH ENDOTRACHEAL OR
TRACHEOSTOMY TUBES.
• IF AIRWAY BYPASSED WHEN PATIENT HAVE
DIFFICULTY IN BREATHING THROUGH EITHER
AN ENDOTRACHEAL OR TRACHEOSTOMY
TUBE.
• DRY AIR AT LOWER TEMPERATURE THEN BODY
TEMP. PASSING THROUGH BRONCHIAL TREE
THAT EXTRACTS MOISTURE FROM THEM THAT
CAUSING CRUSTS TO BE FORMED.

34. • THAT CRUST MAY PARTIALLY BLOCK : TRACHEA
MAIN BRONCHUS
OTHER SMALL
AIRWAYS
• ITS VERY DIFFICULT TO REMOVE BECAUSE CILIARY
ACTION IS DIMINISHED AND EVENTUALLY
DESTROYED

35. • WHEN BREATHING AIR TO WHICH GASES HAVE BEEN
ADDED (O2 MASKS)
• MEDICAL GASES ARE COMPLETELY DRY AND WILL REQUIRE
CONSIDERABLE HUMIDIFICATION.
• ARTIFICIAL HUMIDIFIER PROVIDE GREATER EFFECT ON PATIENT IN
NATURAL HUMIDIFICATION PROCESS.
• WHEN SECRETIONS ARE ABNORMALLY THICK.
• HUMIDIFICATION WILL FACILITATE THEIR REMOVAL.

36. CONTRAINDICATIONS
• WITH A BODY TEMPERATURE BELOW 32°C.
• WITH HIGH SPONTANEOUS MINUTE VOLUMES (>10 L/MIN).
• RECEIVING NONINVASIVE VENTILATION WITH LARGE MASK
LEAKS, BECAUSE THE PATIENT DOES NOT EXHALE ENOUGH
VT TO REPLENISH HEAT AND MOISTURE TO ADEQUATELY
CONDITION THE INSPIRED GAS. ALSO, THE RESISTANCE
AND DEAD SPACE OF THE HME MAY NEGATE THE EFFECTS
OF THE NONINVASIVE POSITIVE PRESSURE AND ADD
ADDITIONAL WORK OF BREATHING.

37. REFERENCES
• DOWNIE A. CASH’S TEXTBOOK OF CHEST, HEART
AND VASCULAR DISORDERS FOR
PHYSIOTHERAPISTS. 4TH EDITION. PG NO.233-
239.

38. THANK YOU