Respiratory Gas Conditioning and Humidification

Schulze, Andreas

doi:10.1016/j.clp.2006.12.009

Cited by 39 publications

(15 citation statements)

References 64 publications

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“…The use of cold dry gas may adversely affect lung function and increase the risk of hypothermia, which is an independent risk factor for mortality in preterm infants [4]. The use of dry ventilator gases has been shown to have a detrimental effect on airway epithelium, ciliary function, mucous viscosity and lung inflammation [5,6]. However, there are no recommendations for conditioning gases during newborn stabilisation.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Practical Considerations for Heating and Humidifying Gases during Newborn Stabilisation: An in vitro Model

Owen

Dawson²,

Middleburgh³

et al. 2014

Neonatology

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Background: Gases for respiratory support at birth are typically ‘cold and dry', which may increase the risk of hypothermia and lung injury. Objectives: To determine the feasibility of using heated humidification from birth. Method: A humidifier targeting 37°C, a manual-fill chamber and a Neopuff Infant T-piece resuscitator and circuit were attached to a face mask and a manikin. Recordings using 20 ml H₂O for humidification and a flow of 10 l/min were undertaken. Temperature and relative humidity (RH) were recorded. Additional recordings were made, each with one alteration to baseline (50 ml H₂O for humidification, auto-fill chamber, a flow of 8 l/min, addition of circuit extension piece, warmed humidification H₂O, increased ambient temperature and targeting 31°C). The duration of heated humidification and the response to disconnecting the power were investigated. Results: The baseline circuit achieved 95% RH and 31°C in 3 min, >99% RH in 7 min and ≥35°C in 9 min. No circuit alterations resulted in faster gas conditioning. The extended length circuit and targeting 31°C reduced the maximum temperature achieved. A flow of 8 l/min resulted in slower heating and humidification. The baseline circuit delivered heated humidification for 39 min. Without power, the temperature and humidity fell below international standards in 3 min. Conclusion: Rapid gas conditioning for newborn stabilisation is feasible using the experimental set-up, ≥20 ml H₂O and a flow of 10 l/min. The circuit could be used immediately once switched on. Without power, conditioning is quickly lost. Investigation of the clinical effects of gas conditioning is warranted.

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Section: Introductionmentioning

confidence: 99%

Feasibility and Practical Considerations for Heating and Humidifying Gases during Newborn Stabilisation: An in vitro Model

Owen

Dawson²,

Middleburgh³

et al. 2014

Neonatology

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“…The gas must be delivered to the airways at 37 1C and 100% humidity to maintain cilial and mucus function and prevent epithelial dehydration. 40 Water vapour permeable ventilator circuits should be used to prevent condensation. 41 Setting the inflation time (T i ) Sufficient T i is required for the pressure to rise to the PIP selected by the ventilator and form a small plateau.…”

Section: Set Expired Volumementioning

confidence: 99%

A practical guide to neonatal volume guarantee ventilation

et al. 2011

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A recent systematic review and meta-analysis shows that volume-targeted ventilation (VTV) compared with pressure-limited ventilation (PLV) reduce death and bronchopulmonary dysplasia, pneumothorax, hypocarbia and severe cranial ultrasound abnormalities. In this paper, we present published research and our experience with volume guarantee (VG) ventilation, a VTV mode available on the Dräger Babylog 8000plus and VN500 ventilators. The VG algorithm measures the expired tidal volume (V T ) for each inflation and adjusts the peak inflating pressure for the next inflation to deliver a V T set by the clinician. The advantage of controlling expired V T is that this is less influenced by endotracheal tube leak than inspired V T . VG ventilation can be used with an endotracheal tube leak up to B50%. Initial set V T for infants with respiratory distress syndrome should be 4.0 to 5.0 ml kg À1 . The set V T should be adjusted to maintain normocapnoea. Setting the peak inflating pressure limit well above the working pressure is important to enable the ventilator to deliver the set V T , and to avoid frequent alarms. This paper provides a practical guide on how to use VG ventilation.

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“…In severe cases, the mucus formed in the wall of tracheal tube leads to the airway obstruction 12,8 . These problems and incidents will be more severe especially in mechanical breathing with a high flow inhalation, long-term breathing, sensitive airways such as asthma and various respiratory tract pathology 10 . The humidification of respiratory gases is a standard care for respiratory devices and is recommended to control airway secretions.…”

mentioning

confidence: 99%

“…The humidity of inhaled air decreases in case of the use of a high oxygen flow 4 , increased ventilation, the use of dried inhaled gases and the use of tracheal tube. The reduction of the moisture content of the inhaled gas leads to the dryness of airway, increased concentration and the viscosity of airway secretions 6 , the dysfunction of cilia 8,7 , the inflammation and the scarring of airways caused by cellular level destruction 13,9 , the destruction of pulmonary tissue 10 , bronchospasm, atelectasis, which results in hypoxia 14 and an increased risk of pulmonary infection 10 . The dried and sticky secretions enter into the tracheal tube and cause the formation of a layer in its wall 11 .…”

mentioning

confidence: 99%

“…However, drying the airway mucosa leads to the disruption of ciliary movement and the airway irritation 8 . The use of mechanical ventilation within a few days, likely leads to the retention of airway secretions 9 , which gradually causes airway obstruction and results in atelectasis or pneumonia 10,11 . Dried phlegm gets into the btracheal tube and obstructs it partially or wholly 12 .…”

mentioning

confidence: 99%

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Investigation of Correct Application of Ventilators‘ Humidifier Systems Before and After Nursing Education in Intensive Care Units

Pouryaghobi¹,

Ahmadinejad²,

Hajimaghsoudi³

et al. 2015

Biosci., Biotech. Res. Asia

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Provision of inspiratory humidity in patients connected to ventilator prevents drying and increasing the density of airway secretions, airway obstruction and following complications. Nursing stuff plays an important role at the correct application of ventilator's humidifiers. In this study we evaluate the effect of nursing education on the correct application of ventilator's humidifiers in intensive care units. This research was done as a randomized double blind study at two stages: At first step, 327 connected ventilators to patient were investigated according to the presence of humidifier, distilled water in the humidifier's container, connection tubes, connectors and connection of humidifier system to inspiratory arm. Then nursing education was done for correct application of ventilator's humidifiers in intensive care units, without previous information about research proposal. At second step, after the nursing education, all stages similar to first step were repeated and the data were recorded in questionnaire. Data were analyzed by SPSS software, Chi-square and fisher tests. According to analysis of data statically, before and after nursing education: The %91.40 and %82.60 of ventilators had humidifier system, respectively, which the reduction was statically significant (P= 0.001). The %49.80 and % 65.20 of humidifier systems had connectors and connective tubes, which the increase was statically significant (P= 0.00). The %39.10 and %47.80 of humidifiers had distilled water in their containers, respectively, which was statically significant (P= 0.04). Active and connected ventilators to patient that had humidifier system, connective tubes connected to inspiratory arm and humidifier's container with distilled water simultaneously were formed %26.60 and %23.50 of ventilators, the difference was not statically significant (P= 0.37). Nursing education for proper and complete usage of humidifiers in patients under ventilators had a few effect that could be caused by: the lack of the supply of humidifier system, the high amount of duties, the personnel shortages, the low motivation of nurses, the lack of personnel attention to the learning and employing their own knowledge and the lack of the knowledge of nurses about the research.

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Respiratory Gas Conditioning and Humidification

Cited by 39 publications

References 64 publications

Feasibility and Practical Considerations for Heating and Humidifying Gases during Newborn Stabilisation: An in vitro Model

Feasibility and Practical Considerations for Heating and Humidifying Gases during Newborn Stabilisation: An in vitro Model

A practical guide to neonatal volume guarantee ventilation

Investigation of Correct Application of Ventilators‘ Humidifier Systems Before and After Nursing Education in Intensive Care Units

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