1. 1 May 2014

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4. 4  The birth of respiratory care  The AARC Clinical Practical Guidelines  The artificial nose May 2014

5. 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. 6 Inhalation Therapy

7. “Scientific adjustment to oxygen and nitrogen” Drs. Starkey and Palen, 1888 Compound Oxygen “Scientific adjustment to oxygen and nitrogen” Drs. Starkey and Palen, 1888 7 May 2014

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10. 10 May 2014

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

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

13. Heated Humidifiers 13 May 2014

14. 14 May 2014

15. 15 May 2014

16. 16 May 2014

17. Humidification During Mechanical Ventilation Humidification During Mechanical Ventilation 17 May 2014

18. Humidification During Mechanical Ventilation Humidification During Mechanical Ventilation 18 May 2014

19. Humidification During Mechanical Ventilation Humidification During Mechanical Ventilation 19 May 2014

20. Humidification During Mechanical Ventilation Humidification During Mechanical Ventilation 20 May 2014

21. Humidification During Mechanical Ventilation Humidification During Mechanical Ventilation 21 May 2014

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

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

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

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

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

27. All “Noses” Are Not Alike! 27 May 2014

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

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

30. 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

31. Examples of Passive and Active HMEs 31 May 2014

32. Examples of Passive Humidifier Designs 32 May 2014

33. Examples of Humidification Media 33 May 2014

34. 34 May 2014

35. 35 May 2014

36. 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 2014 36 Humidification for Patients with Artificial Airways RESPIRATORY CARE; JUNE 1999; VOLUME: 44 NO 6; page 638

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

38. Don’t be Fooled, The 3Cs 38 May 2014

39. 39 May 2014

40. 40 May 2014

41. 41 May 2014

42. Collecting 42 gas in May 2014 gas in gas out

43. Coffee Pour Test 43 May 2014

44. 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

45. Trend of Humidity Delivered HME lowest HMEFHCH HCHF highest 45 May 2014 Respiratory Care; June 1999; Vol. 44 No. 6; Pg. 636

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

47. Is My Patient Being Humidified? 47 May 2014

48. Is My Patient Being Humidified? 48 May 2014

49. Assessment of Sputum Characteristics 49 May 2014

50. Secretions Trend 50 Clear WhiteYellowGreenCreamBrown May 2014

51. ffectiveness Research Independent Documentation of Effectiveness 51 May 2014

52. 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

53. MHRA - Medicines and Healthcare Products Regulatory Agency & UK Medicines Healthcare Products 53 May 2014

54. 54 Richard Branson’s evaluation of 21 HMEs, Table 2. (Respir Care 1996; 41:736-743) May 2014

55. Documentation of PH Effectiveness 55 May 2014

56. An Example - MAUDE Adverse Event Report 56 May 2014

57. Too Late to Check Effectiveness 57 May 2014

58. Early Sputum Collection Cups 58 May 2014

59. Early Coffee Cups 59 May 2014

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

61. What to Look For When Choosing a PH 61 May 2014

62. What to Look For When Choosing a PH 62 May 2014

63. What to Look For When Choosing a PH 63 May 2014

64. What to Look For When Choosing a PH 64 May 2014

65. “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. 65 May 2014

66. Questions? May 2014 66