1. 1 May 2014

2. 2 May 2014

3. 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.
3 May 2014

4. 4 May 2014
Inhalation Therapy

5. 5
Treatment for Respiratory Ailments
Were Common During the Late 1800s
February 2012

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

7. 7 May 2014

8. 8 May 2014

9. 9 May 2014

10. 10 May 2014

11. The American
Association of
Inhalation
Therapy
The University of
Chicago Hospital
establishes the
Inhalation Therapy
Association
in 1946
11 May 2014

12. 12 May 2014

13. An Early Oxygen Tank
13 May 2014

14. 14 May 2014

15. 15
What is
30/30?
February 2012

16. 16
30/30
February 2012

17. 17
Active? Passive? Both?
It is very important for respiratory therapists to evaluate each patient
individually and choose the correct device.
May 2014

18. Clinical Practice Guidelines
During Mechanical Ventilation
18 May 2014

19. 19
November 2011

20. Advantages of Using Active Humidifiers
During Mechanical Ventilation
20 May 2014

21. Advantages of Using Active Humidifiers
During Mechanical Ventilation
21 May 2014

22. Disadvantages of Using Active Humidifiers
During Mechanical Ventilation
• Temperature setting is not humidity delivered
• Costly, possibilities of malfunction and down
time
• Use problems as reported in MAUDE –
Manufacture and User Facility Device
Experience
22 May 2014

23. Disadvantages of Using Active Humidifiers
During Mechanical Ventilation
• May develop condensation within the circuit
• Possible infectious waste (biological hazard)
drainage into heater reservoir, the ventilator
and more
• Complex to use with over or under hydration
possible
• May not produce as much humidity as thought.
23 May 2014

24. Biological Hazards
• Biological hazards refer to biological substances
that pose a threat to the health of living
organisms, primarily that of humans.
• The term and associated symbol are generally
used as a warning, so that those potentially
exposed to the substance will know to take
precautions.
From Wikipedia, the free encyclopedia
24 May 2014

25. Secretions = Biological Hazard
25 May 2014

26. Heated Humidifiers
26 May 2014

27. May 201427

28. 28 May 2014

29. What is an Artificial Nose?
29
November 2011

30. The Artificial Nose
30
November 2011

31. The Artificial Nose
31
November 2011

32. 32 May 2014

33. Humidification During Mechanical Ventilation
33 May 2014

34. Humidification During Mechanical Ventilation
34 May 2014

35. Humidification During Mechanical Ventilation
35 May 2014

36. Humidification During Mechanical Ventilation
36 May 2014

37. Humidification During Mechanical Ventilation
37 May 2014

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

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

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

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

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

43. Advantages of Using Active HME Humidifiers
During Mechanical Ventilation
43 May 2014

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

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

46. 46 May 2014

47. 47
• heat and moisture exchanger
HME
• filter heat and moisture exchanger
FHME
May 2014

48. 48
• hygroscopic condensing humidifier
HCH
• filter hygroscopic condensing
humidifier
FHCH
May 2014

49. 49
• gas flow may be redirected to and
around the media
Bypass HME
• heat and water added to the HME
Active HME
May 2014

50. 50 May 2014
Hygroscopic:
The ability of a substance to attract and hold
water molecules from the surrounding
environment by enhancing the natural physical
properties.
This is achieved through either absorption or
adsorption with the absorbing or adsorbing
material becoming physically "changed.”

51. 51 May 2014
Absorption: Incorporation of moisture. This moisture
becomes a part of the media
Adsorption: Adhesion of moisture to a surface
Adsorption is a surface-based process while absorption
involves the whole volume of the material

52. Coffee Pour Test
52 May 2014

53. Coffee Pour Test
53 May 2014

54. Examples of Passive and Active HMEs
54 May 2014

55. Examples of Passive Humidifier Designs
55 May 2014

56. Examples of Passive Humidifier Designs
56 May 2014
Many flex tubes will
add about 2 mg of
moisture

57. Examples of Trach Passive Humidifier Designs
57 May 2014

58. 58 May 2014

59. Examples of Humidification Media
59 May 2014

60. 60 May 2014

61. Replaced HME
q 24 hours
Bloody secretions?
Thick tenacious sputum?
Less than 70%?
Core temp less 320 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
YES
NO
May 201461
Humidification for Patients with Artificial Airways
RESPIRATORY CARE; JUNE 1999; VOLUME: 44 NO 6; page 638

62. Inconsistent Therapy?
Passive humidifiers and inaccurate active humidification
settings may lead to undesirable sputum outcomes,
endotracheal tube occlusions and/or pneumothorax.
RRT replaces HME and perceives everything to be ok

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

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

66. 66 May 2014

67. 67 May 2014

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

69. 69 May 2014

70. 70 May 2014

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

72. Collecting…
72
gas in
May 2014
gas in
gas out

73. Collecting…
73 May 2014

74. The 3Cs
74 May 2014

75. Most Important Features of PH
75
Filter?
Cost?
Resistance?
Moisture
output?
Dead
space?
Design?
Respiratory Care; June
1999; Vol. 44 No. 6; Pg. 636
May 2014

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

77. Should PH be Chosen Based
Upon Minute Ventilations?
77 May 2014

78. Is My Patient Being Humidified?
78 May 2014

79. 79 May 2014

80. 80 May 2014

81. Sputum Descriptions
81 May 2014

82. Assessment of Sputum Characteristics
82 May 2014

83. Research Independent Documentation
of Effectiveness
83 May 2014

84. 84
This patient was featured on The Learning Channel.
2nd and 3rd 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

85. MHRA & UK Medicines Healthcare Products
85 May 2014

86. 86
Richard Branson’s evaluation of 21 HMEs, Table 2.
(Respir Care 1996; 41:736-743)
May 2014

87. Documentation of PH Effectiveness
87 May 2014

88. MAUDE Adverse Event Report
88 May 2014

89. Early Coffee Cups
89 May 2014

90. Too Late to Check Effectiveness
90 May 2014

91. What to Look For When Choosing a PH
91
???
May 2014

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

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

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

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

96. “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.
96 May 2014

97. May 201497