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Clinical Instruction (Kass) > Humidity and aerosol therapy > Flashcards

Humidity and aerosol therapy Flashcards

1
Q

What is humidification?

A

The act of adding water vapor to a dry gas

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2
Q

T/F: water vapor cannot be seen

A

True

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3
Q

Why is humidification important?

A

Because we are frequently bypassing the bodies natural humidification processes
Dry air can cause irritation to lungs and respiratory tract

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4
Q

What is relative humidity?

A

How much water vapor is in the air compared to how much it could hold at that temperature

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4
Q

What is absolute humidity?

A

A measure of the actual amount of water vapor in the air regardless of the airs temperature

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5
Q

What is the isothermic saturation boundary?

A

The point at which inspired gas reaches body temp and 100% relative humidity

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6
Q

At what temperature does thermal injury to the airway occur?

A

Greater than 45 degrees celsius

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7
Q

What does breathing dry gas do to the ISB?

A

Drives it deeper into the respiratory tract

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8
Q

What is the goal of humidity therapy?

A

To provide adequate heat and humidity
To treat hypothermia
To prevent airway response to cold air
To aid in removal of thick secretions

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9
Q

What are the effects of inadequate humidification?

A

Epithelial integrity decreases
Infection
Inflammation
Disruption of mucociliary transport
Increase in mucous production
Thick secretions
Increase airway irritability
Structural damage to lung

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10
Q

What is an active humidifier?

A

Adds water, heat or both to the inspired gases

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11
Q

What is a passive humidifier?

A

A passive humidifier used exhaled heat and moisture to humidify inspired gas

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12
Q

Describe how a bubble humidifier works

A

In a bubble humidifier dry gas is directed into a water filled reservoir where the stream of gas is broken into bubbles

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13
Q

How does surface area affect humidity

A

Increasing the surface area for the gas water interface increasing the gas exposed to water

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13
Q

How does temperature affect humidity?

A

The water the gas or water is, the more water vapor it can hold

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13
Q

What are the 3 factors that affect the humidity output of a device?

A

Temperature
Surface area
Exposure time

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14
Q

How does exposure time affect humidity?

A

The time a gas is exposed to water can influence humidity
More time, more evaporation

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15
Q

What is the primary application of bubble humidifiers?

A

Humidification of oxygen delivered by a low flow nasal cannula

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16
Q

Describe the efficiency of a bubble bottle

A

Not very efficient

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17
Q

What are the hazards associated with bubble bottle humidifiers?

A

Prolonged use can result in pressure relief valve becoming dysfunctional resulting in pressure build up and bottles bursting
Flow rates greater than 10 L/min can produce aerosols which can transmit bacteria

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18
Q

What oxygen delivery devices can interface with a bubble bottle?

A

Nasal cannulas
Simple masks
Non rebreather masks
Partial rebreather masks

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19
Q

What are the types of passover humidifiers?

A

Simple passover
Membrane
Wick

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20
Q

What is the principle of operation of simple pass over humidifiers?

A

Gas flows over surface, gets humidified, then flows to patient
Low efficiency due to short contact time between gas and water

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21
Q

Describe membrane passover humidifiers

A

Consists of a jar that can be filled with water but with no conduction system for the inspired gas inside the jar
Inspired gas flows into 1 side, passover over the water surface and hydrophobic membrane on the other side and exits to the other side

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22
What temperature range are heated humidifiers capable of delivering?
30-39 degrees celsius
22
How efficient are heated humidifiers?
Very Can deliver 100% relative humidity
23
Describe the efficiency of membrane pass over humidifiers
Low Exposure time and surface area are limited
24
Describe wick pass over humidifiers
Reservoir of water and porous material that absorbs water and provides a larger area for water and air to mix which allows for better evaporation
25
How are water levels maintained in a heated humidifier?
Float system and disposable containers holding sterile water
26
What are the suggested settings for active humidification on an invasively ventilated patient?
Humidity levels between 33 mg H2O/liter and 44 mg H2O/liter 34 - 41 degrees celsius
27
What device helps reduce condensation in ventilator tubing connected to a heated humidifier?
Heated wire tubing
27
T/F: not every patient on invasive ventilation needs humidification
False
28
What level of humidity should a passive humidifier be able to deliver to a invasively ventilated patient?
A minimum of 30 mg H2O/Liter
28
Why is active humidification suggested for NIV?
May improve adherence and comfort
29
When are HMEs not recommended?
Patients with low tidal volumes because they contribute additional dead space which can increase the ventilation requirement and PaCO2
30
What are the hazards associated with heated humidity?
Electrical shock hypo/hyperthermia Burns Tubing meltdown Pooled contaminated condensate
30
T/F: HMEs are recommended as a prevention strategy for VAP
False
31
What can pooled contaminated condensate in circuit tubing result in?
Patient ventilator asynchrony Tracheal lavage Nosocomial infections
32
When using an incubator, where should the temperature probe be placed and why
Outside of the incubator The surrounding air temperature affects humidifier function
32
What kind of humidifier is a HME?
A passive humidifier
33
What are the downsides of HMEs?
Increase dead space Increase work of breathing
33
What causes the efficiency of HMEs to decline?
Increases in tidal volume, inspiratory flow, and increased FiO2
34
How often to HMEs need to be changed?
Every 48 hours
35
When are HMEs contraindicated?
When patient has thick copious secretions When patient circuit or patient system has leaks Patient is hyperthermic Patient minute volume is > 10 l/m
36
When is the use of HMEs most appropriate?
Short term vent patients with no special humidity needs Post op patients who will soon be extubated PACU patients (post anethesia care unit) ER patients Transport patients Some patients on home ventilators Some pediatric patients with trach tubes
37
What is the definition of an aerosol?
Suspension of solid or liquid particles in gas Visible
37
What are the clinical signs and symptoms of inadequate airway humidification?
Atelectasis Dry non productive cough increased airway resistance Increased work of breathing Patient complains of substernal pain and airway dryness Thick dehydrated secretions
38
What are clinical uses for aerosols?
Supplemental oxygen Inflamed airways Hyperthermia Minimize bleeding following a trach Edema Sputum induction Post extubation edema
38
How do you determine whether or not an aerosol delivery device is providing adequate humidity?
The delivered relative humidity is 100% if condensate is seen in the delivery tubing near the patients airway
38
What are the types of bland aerosol delivery devices?
Cool Heated Ultrasonic nebulizers
38
How are large volume jet nebulizers powered?
Pneumatically
39
What can nebulizer therapy be used for?
Cooling Heating Sputum induction Medication
39
T/F: large volume jet nebs cannot deliver precise FiO2 concentrations
False
40
What are the patient interface options for aerosols?
Aerosol mask Face tent Trach collar T-tube
41
What are cool bland aerosols used to treat?
Upper airway edema Laryngotracheobronchitis Subglottic edema Post op management of airway Presence of a bypassed airway Need for sputum specimens or mobilization of secretions
41
What are the clinical uses for heated nebulizers
Increased humidification needs Dry gas delivery Artificial airways Cold reactive airways Hypothermia Thick secretions
42
Describe ultrasonic nebulizers
Works on piezoelectric principle, crystal transducer converts electrical signal into high frequency acoustic vibrations that form waves and generate a geyser of droplets that become fine aerosol particles
43
What are some of the risks associated with heated jet nebulizers?
May not shut down when reservoir is empty Not sophisticated or accurately temp control
44
Why might you choose an ultrasonic nebulizer over a bland aerosol large volume neb?
The ultrasonic is more efficient
45
What can affect the particle size and aerosol density of a ultrasonic nebulizer?
Frequency of crystal vibrations Signal amplitude Source and flow of gas
46
T/F: Ultrasonic nebs are only used for bland medication therapy
False. They can be used for bland and medication therapy
47
Describe humidity
Water as a gas Molecular Invisible
48
What temperature and humidity should be delivered when patients are getting gasses delivered by mouth?
20-22 degrees C 50% relative humidity (36-40 mg/L)
48
What temperature and humidity should be delivered when patients are getting gasses delivered to trachea?
32-40 degrees C 36-40 mg/L (> 90% relative humidity)
49
Describe an aerosol
A suspension Particulate Visible
50
What are the primary factors affecting aerosol delivery?
Inertia Gravity Diffusion
51
T/F: warmer gases hold more water vapor
true
52
T/F: Aerosols are water vapor
False
53
When setting up a heated large volume nebulizer to place on a patient with an ETT, what interface would you pick?
T-piece
54
Describe humidity
Is water in a gaseous form or water vapor Is the act of adding water vapor to an anhydrous gas Cannot be seen
55
what can inadequate humidity cause?
A disruption of the mucociliary transport system Decreased epithelial integrity leading to inflammation and infection An increase in mucus production
56
Clinical signs of inadequate humidity can include
Atelectasis A non productive cough Increased airway resistance Increased WOB Substernal pain Thick dehydrated secretions
57
What devices can use heated humidifiers?
ventilators HHFNC CPAP machines
58
Why is the wick humidifier extra efficient?
has increased surface area
59
A patient with an artificial airway can be placed on what humidification devices?
HME heated passover heated wick passover
60
Who are HMEs usually recommended for?
Patients who will not be on the ventilator for very long Patients who are in the post anesthesia care unit
61
What are the goals of heated humidity therapy
Mobility of secretions Providing adequate heat and humidity Preventing airway response to cold air Treating hypothermia

Clinical Instruction (Kass) (13 decks)

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