CPAP and Humidification Therapy
Peggy Powers, RRT
Clinical Education
Fisher and Paykel Healthcare
Conflict of Interest Disclosure(s)
I do not have any potential conflicts of
interest to disclose
MY CPAP GAVE ME A COLD!
Up to 75% of patients
receiving CPAP therapy suffer
from nasal congestion and
upper airway congestion.
Inhalation of cool dry
air increases nasal
congestion and
causes inflammation,
this accounts for the
patient reporting
“MY CPAP GAVE ME A
COLD”
Due to vascular
reactivity of
the turbinate’s
and nasal
congestion,
nasal
resistance may
increase and
the patient
may present
with:
• Claustrophobia
• Receiving inadequate airflow
• Mouth breathing
• Unconscious removal of the
CPAP mask at night
Environment
Dusty house
Cluttered house
Pet dander
Cold House
Hot House
Demographics/Climate
•
•
•
•
•
Desert
Ocean
Altitude
Swamp
Jungle
Background to Humidification
Background to Humidification
What is Humidity?
•
Humidity is the amount of water vapor in a gas
• Describing humidity
– Absolute Humidity
– Relative Humidity
• Key humidity concepts
– Maximum Capacity
– Dew point
Absolute Humidity (AH)
15 mg/L Absolute
Humidity
30 mg/L Absolute
Humidity
1L
15 mg
30 mg
• mgH2O/L is usually referred to as mg/L
Relative Humidity (RH)
50% Relative Humidity
100% Relative
Humidity
1L
30 mg
30 mg
15 mg
30
• % = content/capacity x 100
Maximum Capacity
30 mg/L
27 mg/L
24 mg/L
22 mg/L
19 mg/L
17 mg/L
15 mg/L
18 ºC
20ºC
22 ºC
24 ºC
26 ºC
28 ºC
30 ºC
Dew Point
• The temperature at which water
vapor begins to condense
– Cooling process
• Here, the gas is fully saturated i.e.
100% Relative Humidity
Humidification & the Upper Airway
Anatomy of the Airway
•Gross anatomy of the airway
•Three main regions:
Naso-pharynx
Oro-pharynx
• Naso-pharynx
• Oro-pharynx
• Trachea
Trachea
Inspiration
22 °C
Room Air
7 mg/L, 35% RH
31 °C
Naso/Oropharynx
30 mg/L, 90% RH
36 °C
Trachea
42 mg/L, 100% RH
37 °C
Isothermic Saturation
Boundary
44 mg/L, 100% RH
Nasal Symptoms
• The airway is a natural heated humidifier
• A constant flow of air delivered via CPAP can dry the nasal
mucosa
• Excessive drying of the nasal mucosa increases nasal
resistance, thereby increasing nasal discomfort
• Production of mucus is also increased to help humidify the
additional air flow
• These factors can induce symptoms such as nasal congestion
Nasal Congestion
• Nasal congestion is a narrowing/blockage
of the nasal passages
• It is usually due to membranes lining the
nose becoming swollen from inflamed
blood vessels.
• Nasal congestion is also known as nasal
obstruction, blocked nose, runny nose, or
stuffy nose.
Nasal Symptoms
• Nasal symptoms can be alleviated by the use of a humidifier
with your CPAP
• When the flow of air is already humidified this reduces the
demand on the bodies natural humidification system
Available Humidification Technologies
Humidification Delivery Modes
• No humidity
• Cold pass-over
• Conventional heated humidification
• Heated breathing tube
No Humidification
CPAP treatment where no
humidity is delivered to patients
Effectively delivers ambient air
Effects of No Humidification
Nasal symptoms - dryness of nasal
mucosa & nasal congestion
Mouth leak
Therapy abandonment
Cold Pass-Over Humidification
What is cold pass-over humidification?
•
Passing of cold air over water
•
An interim treatment for patients who complain of nasal
symptoms after initiation of CPAP
Effects of Cold Pass-over
No clinical evidence available to support the use of
cold pass-over
Increase in nasal resistance on dry CPAP (no
humidification) are unchanged with cold pass-over
Mouth leak
Therapy abandonment
Conventional Heated Humidification
What is conventional heated humidification?
• Heating the water filled chamber using a heater plate
• Air passing over the heated water adds moisture and humidifies
the delivered air
• Turbulence induced in the chamber helps pick up humidity
Benefits of Conventional Heated Humidification
1. Alleviates reported nasal discomfort
2. Lowers therapy abandonment
3. Improves patient compliance
4. Reduces the incidence of mouth leak
Limitations of Conventional Heated Humidification
• Ambient air temperature
• Condensation
• Disruptive noise leading to fluctuating mask pressure
Condensation – Conventional Humidification
30 oC
29 mg/L
20 oC
17 mg/L
TUBE COOLING = CONDENSATION BUILD UP = PATIENT DISRUPTION
Condensation
Bacon et al, 2000
Heated Breathing Tube (HBT)
What is the idea behind the heated breathing tube?
• Copper wire coiled inside breathing tube
• Discounts the effects of changing ambient temperature
• Operates in its own controlled environment
Conventional vs HBT
Conventional
Timeline
2hrs
Conventional Humidification
30mg/L
18 mg/L
TUBE COOLING - CONDENSATE FORMS
Timeline
2hrs
Heated Breathing Tube Humidification
HBT
30mg/L
30mg/L
WARM TUBE: HEAT LOSS + HEAT GAIN = CONSTANT HEAT
HBT
Clinically Proven for A Better Nights Sleep
ThermoSmart™
THE ORIGINAL HEATED BREATHING TUBE
•
•
•
FPH 40 years of experience in humidification technology
5 years of global ThermoSmart™ market experience
Dedicated research program
Sensors & algorithms in place of RH and EOH sensors
The sophisticated algorithm used
means the results achieved by an end
of hose RH sensor can be mimicked
Different levels of RH are built into
each ThermoSmart™ Boost setting
F&P consistently delivers higher levels
than both the SystemOne and S9
systems
Proven Clinical Research
Clinical Studies support the effectiveness
of ThermoSmart™:
• Nilius: improves sleep quality and total sleep time
• Almasri: provides a more comfortable CPAP
experience
• Virag: eliminates condensation while delivering
higher levels of absolute humidity
• Massengill: lowers nasal airway resistance for 10%
lower titration pressure
HBT
START WITH THERMOSMART™
Clinical Summary
The addition of
a heated
breathing
circuit to a
delivery
system:
• Ensures stable gas temperatures
• Allows for higher humidity levels to be
delivered
• Increased patient comfort and therefore
compliance
• Eliminates condensation
• Ensures mask pressure stability
• No sleep cycle disruptions from tubing noise
End