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The birth of respiratory care
The AARC Clinical Practical Guidelines
The artificial nose
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The Artificial Nose:
 How does it function
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The 6 types of passive humidifiers
Design
The 3 Cs
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Moisture media
Important features
 Documentation of effectiveness
 What to look for when choosing a passive humidifier
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Compound Oxygen
“ Scientific adjustment to oxygen and nitrogen ”
Drs. Starkey and Palen, 1888
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Active? Passive? Both?
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It is very important for respiratory therapists to evaluate each patient individually and choose the correct device.
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Clinical Practice Guidelines
During Mechanical Ventilation
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Heated Humidifiers
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Humidification During Mechanical Ventilation
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Humidification During Mechanical Ventilation
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Humidification During Mechanical Ventilation
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Humidification During Mechanical Ventilation
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Humidification During Mechanical Ventilation
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Advantages of Using Passive Humidifiers
During Mechanical Ventilation
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Disadvantages of Using Passive Humidifiers
During Mechanical Ventilation
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Disadvantages of Using Passive Humidifiers
During Mechanical Ventilation
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Advantages of Using Active HCH Humidifiers
During Mechanical Ventilation
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Disadvantages of Using Active HME Humidifiers
During Mechanical Ventilation
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All “Noses” Are Not Alike!
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HME
• heat and moisture exchanger
FHME
• filter heat and moisture exchanger
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HCH
• hygroscopic condensing humidifier
FHCH
• filter hygroscopic condensing humidifier
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Bypass HME
• gas flow may be redirected to and around the media
Active HME
• heat and water added to the HME
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Examples of Passive and Active HMEs
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Examples of Passive Humidifier Designs
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Examples of Humidification Media
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Examine patient’s
Hx/Px
NO
Bloody secretions?
Thick tenacious sputum?
Less than 70%?
Core temp less 32 0 C?
Replaced HME q 24 hrs?
Evaluate secretion quality and quantity
Examine patient
More than 4 HMEs used in 24 hours?
NO
Humidification for Patients with Artificial Airways
RESPIRATORY CARE; JUNE 1999; VOLUME: 44 NO 6; page 638
YES Use heated humidification
YES
May 2014

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

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Don’t be Fooled, The 3Cs
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Collecting
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Coffee Pour Test
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Most Important Features of PH
Filter?
Design?
Cost?
Dead space?
Resistance?
Moisture output?
Respiratory Care; June
1999; Vol. 44 No. 6; Pg. 636
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Trend of Humidity Delivered
HME lowest
HMEF HCH
HCHF highest
Respiratory Care; June 1999; Vol. 44 No. 6; Pg. 636
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Should PH be Chosen Based
Upon Minute Ventilations?
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Is My Patient Being Humidified?
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Is My Patient Being Humidified?
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Assessment of Sputum Characteristics
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Clear White Yellow Green Cream Brown
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Research Independent Documentation of Effectiveness
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This patient was featured on The Learning Channel.
2 nd and 3 rd 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
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MHRA - Medicines and Healthcare Products Regulatory
Agency & UK Medicines Healthcare Products
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Richard Branson’s evaluation of 21 HMEs, Table 2.
(Respir Care 1996; 41:736-743)
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Documentation of PH Effectiveness
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An Example - MAUDE Adverse Event Report
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Too Late to Check Effectiveness
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Early Sputum Collection Cups
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Early Coffee Cups
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What to Look For When Choosing a PH
???
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What to Look For When Choosing a PH
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What to Look For When Choosing a PH
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What to Look For When Choosing a PH
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What to Look For When Choosing a PH
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“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.
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