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4  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 5 May 2014

6 Inhalation Therapy

“Scientific adjustment to oxygen and nitrogen” Drs. Starkey and Palen, 1888 Compound Oxygen “Scientific adjustment to oxygen and nitrogen” Drs. Starkey and Palen, May 2014

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11 Active? Passive? Both? It is very important for respiratory therapists to evaluate each patient individually and choose the correct device. May 2014

During Mechanical Ventilation Clinical Practice Guidelines During Mechanical Ventilation 12 May 2014

Heated Humidifiers 13 May 2014

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Humidification During Mechanical Ventilation Humidification During Mechanical Ventilation 17 May 2014

Humidification During Mechanical Ventilation Humidification During Mechanical Ventilation 18 May 2014

Humidification During Mechanical Ventilation Humidification During Mechanical Ventilation 19 May 2014

Humidification During Mechanical Ventilation Humidification During Mechanical Ventilation 20 May 2014

Humidification During Mechanical Ventilation Humidification During Mechanical Ventilation 21 May 2014

Advantages of Using Passive Humidifiers During Mechanical Ventilation Advantages of Using Passive Humidifiers During Mechanical Ventilation 22 May 2014

Disadvantages of Using Passive Humidifiers During Mechanical Ventilation Disadvantages of Using Passive Humidifiers During Mechanical Ventilation 23 May 2014

Disadvantages of Using Passive Humidifiers During Mechanical Ventilation Disadvantages of Using Passive Humidifiers During Mechanical Ventilation 24 May 2014

Advantages of Using Active HCH Humidifiers During Mechanical Ventilation Advantages of Using Active HCH Humidifiers During Mechanical Ventilation 25 May 2014

Disadvantages of Using Active HME Humidifiers During Mechanical Ventilation Disadvantages of Using Active HME Humidifiers During Mechanical Ventilation 26 May 2014

All “Noses” Are Not Alike! 27 May 2014

28 heat and moisture exchangerheat and moisture exchanger HME filter heat and moisture exchangerfilter heat and moisture exchanger FHME May 2014

29 hygroscopic condensing humidifierhygroscopic condensing humidifier HCH filter hygroscopic condensing humidifierfilter hygroscopic condensing humidifier FHCH May 2014

30 gas flow may be redirected to and around the mediagas flow may be redirected to and around the media Bypass HME heat and water added to the HMEheat and water added to the HME Active HME May 2014

Examples of Passive and Active HMEs 31 May 2014

Examples of Passive Humidifier Designs 32 May 2014

Examples of Humidification Media 33 May 2014

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Replaced HME q 24 hrs? Bloody secretions? Thick tenacious sputum? Less than 70%? Core temp less 32 0 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 NO May Humidification for Patients with Artificial Airways RESPIRATORY CARE; JUNE 1999; VOLUME: 44 NO 6; page 638

Patient’s humidity level drops over time RRT replaces HME and perceives everything to be ok

Don’t be Fooled, The 3Cs 38 May 2014

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Collecting 42 gas in May 2014 gas in gas out

Coffee Pour Test 43 May 2014

Most Important Features of PH 44 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 HMEFHCH HCHF highest 45 May 2014 Respiratory Care; June 1999; Vol. 44 No. 6; Pg. 636

Should PH be Chosen Based Upon Minute Ventilations? 46 May 2014 Humidifiers should deliver 30/30 for all Minute Volumes

Is My Patient Being Humidified? 47 May 2014

Is My Patient Being Humidified? 48 May 2014

Assessment of Sputum Characteristics 49 May 2014

Secretions Trend 50 Clear WhiteYellowGreenCreamBrown May 2014

ffectiveness Research Independent Documentation of Effectiveness 51 May 2014

52 This patient was featured on The Learning Channel. 2 nd and 3 rd 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 - Medicines and Healthcare Products Regulatory Agency & UK Medicines Healthcare Products 53 May 2014

54 Richard Branson’s evaluation of 21 HMEs, Table 2. (Respir Care 1996; 41: ) May 2014

Documentation of PH Effectiveness 55 May 2014

An Example - MAUDE Adverse Event Report 56 May 2014

Too Late to Check Effectiveness 57 May 2014

Early Sputum Collection Cups 58 May 2014

Early Coffee Cups 59 May 2014

What to Look For When Choosing a PH 60 ??? May 2014

What to Look For When Choosing a PH 61 May 2014

What to Look For When Choosing a PH 62 May 2014

What to Look For When Choosing a PH 63 May 2014

What to Look For When Choosing a PH 64 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 Mar; 113(3): 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. 65 May 2014

Questions? May