humidifier .pptx

Humidifier
Physiotherapy

1. HUMIDIFICATION Dr.Krishna gohil (PT)

2. CONTENT INTRODUCTION DEFINITION WHAT IS THE REQUERMENT OF IT? HOW DOES IT WORK? TYPES METHODS INDICATIONS CONTRAINDICATION

3. INTRODUCTION In our upper respiratory system the nose has a number of important functions including warming, humidifying and filtering the air.

4. INTRODUCTION The high flow rates delivered by Non Invasive ventilation can produce drying of the airway, this can lead to changes in ciliary activity, mucous secretion and increase nasal resistance. Humidification is mandatory while patient unable to breath by their original airway(upper respiratory) and its done through another way: Breath from mouth Endotracheal route

5. DEFINITION Humidification : Moisturizing of the air or gases we breathe. This is normally one of the functions of the upper respiratory tract. 1 Or Humidity therapy involves adding water vapor and (sometimes) heat to the inspired gas. 2 Patricia A. Downie , Cash’s textbook of chest, heart and vascular disorders for physiotherapists, 4 th edition. Robert M. Kacmarek , James K. Stoller, Albert J. Heuer, Egan’s fundamentals of respiratory care, 12 th edition.

6. humidity is water in its gaseous or molecular form and its quantity depends on the temperature of the gas and is expressed as absolute humidity (AH) and relative humidity (RH). AH : the amount of water in a given volume of gas, is usually expressed in milligrams per liter (mg/L). RH : the amount of water vapor in a volume of gas, is expressed as a percentage of the amount of water vapor required to fully saturate that gas at the same temperature and pressure.

7. How is it work..? During mechanical ventilation upper airway is bypassed by the ETT or tracheostomy tube or while face mask (dry gases) and rest of the airway not able to provide enough moisture and heat to the delivered gases. And that are the dry and colder then body temperature. Humidification and heating is essential to avoid complications such as hypothermia, thickness of airway secretions, destruction of airway epithelium and atelectasis.

8. Humidifier that operates to increase the heat and water vapour content of the gases is interposed in the inspiratory limb of the ventilator circuit and the temperature is usually set to deliver approximately 37 ̊ c to the distal area of the circuit.

9. METHOD Humidification is effectively delivered to the patient only by wide bore tubing (narrow – condensation, it’ll occur block).

10. METHODS OF HUMIDIFICATION FREE BREATHING MECHANICAL VENTILATION IPPV NOT INTUBATED WITH TRACHEASTOMY TUBE FACE MASK MOUTH PIECE TRACHEASTOMY HUMIDIFING T-TUBE TRACHEASTOMY MASK

11. Face mask Temperature maintain by mechanical setup. Cover the whole mouth and nose.

12. Mouth piece Patient has to hold it. Used with nebulizer as a method of giving short period of humidification before chest clearance.

13. Tracheostomy mask Now usually disposable Made up from flexible and rigid plastics. But not mostly used flexible plastic.

14. Tracheostomy humidifying T-tube Brompton tube Made up from plastic. Directly fit on the wide bore tubing and the tracheostomy. Also used in patient with an Endotracheal tube.

15. IPPV A patient on intermittent positive pressure ventilation. Its essential that patient receive the humidification which on IPPV. The ideal temperature of Endotracheal tube and tracheostomy entrance should be 34 ̊ C ± 2 ̊ C and that’s the maintain by humidifier.

16. TYPES OF HUMIDIFIER Classified by Boys and Howells (1972) Suppliers and conservers of water Then subdivide into former group SUPPLIERS Ambient temperature vapour suppliers Heated vapour suppliers Ambient aero

17. AMBIENT TEMPERATURE VAPOUR SUPPLIERS its also called bubble humidifier. It consist of a bottle or reservoir partially filled with water attached to a conduction system that filled with water attached to a conduction system that allows the inspired medical gases to be introduced below the water surface. A diffuser that is usually either a form or a metallic mesh is attach to the end of the conduction system.

18. Indication: it is used to humidify the inspired medical gases delivered to patient via a cannula or face mask. Contraindication: patient with endotracheal tube, a tracheostomy or tenacious secretions. Hazard: whenever high rates are used, bubble humidifiers can produce aerosols. These water droplets can transmit pathogenic bacteria from the humidifier reservoir to the patient.

19. HEATED VAPOUR SUPPLIERS Gas is passed through hot water. May be dripped onto a very hot plate The patient tubing may be lagged or heated To prevent temperature loss and ‘rain out’ Device has no more capacity then 39 ̊ C So there is no danger of burn

20. Indication: it provide a high level of humidity and heat, and for that reason are mainly used in intubated and ventilated patients. Hazard: risk of electrical shock If the temp. is not adequately set, it can results in hypo or hyperthermia and thermal injury of airway.

21. AMBIENT AEROSOL SUPPLIERS For produce the mist of liquid water Breaking up water rhythm by high pressure gas jet on anvil OR generating mist with high speed spinning disc / ultrasonic vibrating crystal.

22. AMBIENT AEROSOL SUPPLIERS Many of these devices are oxygen operated and managing room air in varying amount according to the oxygen percentage required. Total gas flow varies with the pattern and its become more noisy when low O2 concentrations are used.

23. Indication: large volume jet nebulizer. Upper airway oedema, subglottic oedema. Whenever need of mobilization of secretions and sputum specimen. Contraindication: history of upper airway hyperresponsiveness and risk of bronchorestriction .

24. HEATED AEROSOL SUPPLIERS The water should be heated In particular the Bernoulli type devices are often made to take a heating element or ‘ hot rod’. Thermal safety is essential. water may be simply added to the airway by direct instillation from a syringe, drip set or pump.

25. CONSERVERS HEAT AND MOISTURE EXCHANGERS (HMEs) Also called condenser humidifiers. Trap expired heat and water in a mesh Return it to in fresh inspired gas. Prone to blockage by secretions. Examples : Portex , Simemens , Engstorm .

26. CONSERVERS

27. CHOICE OF HUMIDIFIER Humidifiers to be choose: When secretions are already thick, droplet humidity is better at loosening then the vapour. Ultrasonic are the best for this purpose. Its also irritant and promote coughing. Kendall model can be persuaded to do so with some difficulty. Venturi devices.

28. CHOICE OF HUMIDIFIER Not to be choose: Cold droplets : its cause Bronchoconstriction and its unsuitable for Asthmatics Chronic obstructive airway disease Some form of heart disease : mitral valve disease Its also cause hypothermia : water deposited in the airway uses body heat in order to vapourise. Ultrasonics may cause a water overload in a susceptible patient and should probably be avoided altogether in children.

29. CHOICE OF HUMIDIFIER Totally disposable humidifiers are convenient and clean, but at present there is no model available which can conveniently deliver less than 28% oxygen together with warm humidity. It is needed for: Respiratory failure Chronic bronchitis Asthma emphysema

30. indication s When breathing through Endotracheal or tracheostomy tubes . If airway bypassed when patient have difficulty in breathing through either an Endotracheal or tracheostomy tube. Dry air at lower temperature then body temp. passing through bronchial tree that extracts moisture from them that causing crusts to be formed.

31. That crust may partially block : Trachea Main bronchus Other small airways Its very difficult to remove because ciliary action is diminished and eventually destroyed

32. When breathing air to which gases have been added (O2 masks) Medical gases are completely dry and will require considerable humidification. Artificial humidifier provide greater effect on patient in natural humidification process. When secretions are abnormally thick. Humidification will facilitate their removal.

33. contraindications With a body temperature below 32°C. With high spontaneous minute volumes (>10 L/min). Receiving noninvasive ventilation with large mask leaks, because the patient does not exhale enough VT to replenish heat and moisture to adequately condition the inspired gas. Also, the resistance and dead space of the HME may negate the effects of the noninvasive positive pressure and add additional work of breathing.

34. REFERENCES Downie A. Cash’s Textbook of Chest, Heart and Vascular Disorders for Physiotherapists. 4 th edition. Pg no.233-239.

35. THANK YOU