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CI2 > Advanced Oxygen Therapy & Humidification > Flashcards

Advanced Oxygen Therapy & Humidification Flashcards

1
Q

What is important for effective function of cilia?

A

Depth of the periciliary (sol) layer

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2
Q

How can oxygen therapy cause impaired sputum clearance?

A

Causes dehydration of the airways & increased viscosity of sputum = impaired sputum clearance

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3
Q

What are the 2 categories of humidifiers?

A
  • Home-based vaporisers

- Hospital/personal

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4
Q

What is the function of home-based vaporisers?

A
  • Increases H2O content of room
  • Typically short term use
  • Can have issues with dampness (not used in hospitals)
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5
Q

What is a common type of hospital/personal humidifiers?

A

High flow nasal prongs (HFNP)

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6
Q

What are the benefits of HFNP?

A
  • Maintains adequate oxygenation plus humidification
  • Provides small amount of positive end expiratory pressure
  • Patient still able to talk, eat & drink
  • Precise FiO2 delivery (21-80%)
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7
Q

What are the CIs to HFNP?

A
  • Significant facial trauma
  • Patients requiring continuous nebulisers (can use spacer with HFNP)
  • Any condition where positive pressure would be a problem (e.g. undrained pneumothorax)
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8
Q

What are the considerations for HFNP delivery?

A
  • High flow will help reduce WOB
  • FiO2 should be titrated to SpO2
  • Encourage nose breathing (mouth closed = PEEP)
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9
Q

What is a disadvantage of HFNP?

A
  • Humidifier chambers do not have a portable battery (i.e. need to be plugged in)
  • Need to consider other options for mobilisation
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10
Q

What physio techniques can be combined with HFNP?

A
  • Cough/huff
  • PEP devices (bubble, flutter)
  • Percs & vibes
  • ACBT/FET
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11
Q

What is the function of nebulisers?

A
  • Deliver high flow of air/O2 through small aperture
  • Causes aerosolisation of particles
  • Can be used for medications, H2O (humidification), saline
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12
Q

What are the different types of nebulisers?

A
  • Wall oxygen/air-based

- Ultrasonic

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13
Q

What is induced sputum?

A
  • Specific procedure to obtain a sputum sample from some not currently producing sputum
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14
Q

What 2 main conditions is induced sputum used for?

A
  • Tuberculosis: Airborne infection, mostly asymptomatic

- Pneumocystis pneumonia (PCP): Fever, non-productive cough (sputum too viscous), SOB

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15
Q

What are the precautions of induced sputum?

A
  • Need gown, gloves, duckbill mask

- Need to be in a negative pressure room

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16
Q

How does induced sputum work?

A
  • Inhalation of nebulised hypertonic saline
  • Movement of fluid draws disease cells across alveolar membrane to allow detection on sputum sample
  • Induces coughing & salivation
17
Q

When are the indications for humidification?

A
  • Patient requires continuous O2 >24 hours (especially at high flow rates)
  • Patient already has problems with sticky sputum
18
Q

What are the limits of O2 therapy?

A

If patient cannot maintain adequate oxygenation with O2 flow they may need positive pressure

19
Q

What are the two types of positive pressure for augmentation of oxygenation?

A
  • Invasive ventilation (ICU)

- Non-invasive ventilation (CPAP, BiPAP)

20
Q

What is invasive ventilation?

A
  • Mechanical ventilation

- Machine-supported breaths delivered deep into lungs, bypassing usual nose/mouth route

21
Q

How is air invasively pumped into lungs?

A
  • Need an artificial airway

- Either endotracheal tube or tracheostomy

22
Q

How are endotracheal tubes positioned?

A
  • Inserted through the mouth & larynx
  • Held in place by cuff/balloon & tapes
  • Should terminate 3-5cm above carina on CXR
  • Usually limited to 7 days due to risk of damage to airways & larynx
23
Q

What is a tracheostomy?

A
  • Direct opening into an airway, bypassing upper airway
  • Ventilation > 7-10 days
  • Reversible, but may scar
24
Q

What are the types of tracheostomies?

A
  • Mini tracheostomy: Secretion management
  • Surgical: General anaesthetic in OT
  • Percutaneous: Local anaesthetic in ICU
  • Cricothyroidotomy: Emergency
25
Q

What are the types of tracheostomy tubes?

A
  • Mini tracheostomy
  • Portex
  • Shiley (long-term use)
  • Silver (permanent use)
26
Q

What type of tracheostomy tubes do mechanically ventilated patients require?

A

Cuffed tubes

27
Q

What is the difference between an inflated & deflated cuff?

A
  • Inflated: Isolates upper airway from lower, air cannot flow through upper airway
  • Deflated: Allows air to move through upper airway
28
Q

What are the issues associated with under inflation of the cuff?

A
  • Aspiration/secretion

- Under ventilation in ventilated patient

29
Q

What are the issues associated with over inflation of the cuff?

A
  • Tracheomalacia
  • Tracheo-oesophageal fistula
  • Inflammation of tracheal wall
  • Formation of granulation tissue
  • Tracheoinnominate fistula
  • Tracheal stenosis
30
Q

What pressure of H2O is acceptable on a manometer?

A
  • 15-25cm H2O

- May be higher in ventilated patients

31
Q

What are the indications for temporary tracheostomy?

A
  • Prolonged intubation (<10-14 days) - decreases risks & side effects of ET tube
  • Comfort
  • Long term unconsciousness/coma
  • Glossal muscle paralysis/inability to swallow
  • Loss of laryngeal reflexes
  • Foreign body
  • Severe neck/mouth injuries
  • Inhalation injuries (e.g. smoke)
32
Q

What are the benefits of temporary tracheostomy?

A
  • Decreases aspiration
  • Decreases airway compression/obstruction
  • Decreases deadspace by up to 50%
  • Decreases sedation requirement
  • Aids secretion removal
  • Facilitates normal eating & drinking
33
Q

What are the consequences of temporary tracheostomy?

A
  • Loss of speech (unless speaking valve)
  • Increased infection risk
  • Decreased humidification
  • Decreased cough reflex
  • Increased aspiration risk
  • Decreased appetite
34
Q

How does a tracheostomy affect humidification?

A
  • Bypasses upper airway, compromising humidification
  • Lower airways become drier
  • Cilia of lower airways less effective at clearing secretions
35
Q

What are the signs of poor humidification?

A
  • Secretions sticking to inside of TT
  • Thicker sputum
  • Absence of sputum
  • Bleeding from tracheal wall
  • Atelectasis due to sputum plug
36
Q

How can humidification & heat be added if nasopharnyx is bypassed?

A
  • Hydration
  • Tracheostomy mask
  • Swedish nose
  • Laryngectomy-permanent tracheostomy protector
  • Heated water
  • Heat & moisture exchanges
  • Nebulisers
  • Steam inhalers
37
Q

What are the pros & cons of heat moisture exchangers (HME)?

A

Pros:

  • Portable, convenient
  • Can be placed directly onto hub of TT or used within ventilator circuit

Cons:

  • Provide less humidification than hot water humidifiers
  • Unsuitable if copious secretions
38
Q

What is the benefit of permanent tracheostomy?

A

Maintains airway when there is neurological or anatomical abnormality

CI2 (17 decks)

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