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Aerosol Drug Therapy

Humidity and Bland Aerosol Therapy

QuestionAnswer
What is Humidity Therapy? The addition of molecular water vapor to a gas delivered to the airway.
What are results of a dry airway? Increased mucus production. Thickened Secretions. Decreased Cilia funtion Increased airway irritability
What patient population are most susceptible to a dry airway? Patients with bypassed airways
What are the normal functions of the upper airway? Filter Heat Humidity
Where does inspired air achieve BTPS conditions? At the Carina
Which part of the upper airway heats and humidifies on inspiration? The nose, it's more efficient than the mouth.
What happens to inspired gas on expiration? It cools and transfers heat to the cool trachea. It condenses and returns to the airway.
What is relative humidity? The ratio comparing absolute humidity to its saturated capacity at a given temperature.
How is relative humidity expressed? As a percentage
Absolute humiditity is? The actual water vapor present
What is saturated capacity? The maximum amount of vapor a gas can hold.
What is the saturated capacity of body temperature? 43.8 mg/L
How do you calculate relative humidity? Absolute humidity divided by saturated capacity X 100
What is the humidity deficit? the amount of water vapor that the body must add to inspired gas to achieve 100% relative humidity at body temperature.
How do you calculate the humidity deficit? capacity at body temperature- absolute humidity
What is body humidity? The ratio comparing absolute humidity to the saturated capacity at body temperature?
How do you calculate body humidity? absolute humidity/saturated capacity X body temp
What is the goal of humidity therapy? To maintain normal physilogic conditions in the airway.
What are indications for humidity therapy. Humidity dry medical gases Overcome the humidity deficit when upper airway is bypassed. Managing hypothermia treat bronchospasm caused by cold air.
What is humidifier? A device that adds molecular water vapor to a gas
Facts about humidifiers. Should provide at least 60% relative humidity at BTPS. Some humidifiers can be heated. Intubated patients need 30 mg/L of water vapor
What are the 3 variables that govern humidifier function? Temperature surface area time of contact
Temperature The greater the temperature the greater the water output
Surface area The greater the surface area, the greater the evaporation, the greater the vapor output
Time of contact The greater the contact time, the greater the evaporation, the greater the water vapor output
What are the types of humidifier systems? Room Bubble Passover Heat Moisture Exchanger (HME)
Bubble Humidifier Pneumatically powered (powered by gas) Not heated Inneficient Absolute humidity approximately 15-20 mg/L
What is the bubble humidifier used with? Simple oxygen delivery devices. (i.e. cannula)
What safety feature does the bubble humidifier have? A pop off safety valve for pressure relief (Audible, pops off at 2 PSIG)
How is a passover humidifier powered? It can be pneumatically and electrically powered.
What are the three tips of passover humidifiers? Simple resivoir passover Wick Membrane
What are some facts about the passover humidifier? It is heated very efficient (30+ mg/L) Used with mechanical ventilators
Simple resivoir passover humidifier Directs gas over surface of water and picks up vapor. (CPAP/Heated or non heated) It can maintain saturated gas at high flow rates. It's functional at high flow rates due to low resistance to airflow.
Wick passover humidifier It's heated an very efficient Passes over heater/saturated wick. It does not bubble.
Membrane passover humidifier Separates water from the gas stream by means of a hydrophobic membrane. It is heated and only allows water vapor to come through but blocks liquid water.
What do active humidifiers use? Electric heat
What do passive humidifiers use? The body heats it with exhaled gas.
What is an example of a passive humidifier? Heat moisture exchanger (HME) AKA artificial nose
How is the HME powered? Passive/patient powered
How does the HME work? It captures exhaled heat and water vapor and uses it to heat and humidify the next breath.
What is the efficiency rating? Approximately 70%
How is the Heat Moisture exchanger used? With artificial airways/mechanical ventilators
What are the contraindications to an HME? Presence of copious, thick, or bloody secretions; leak around ETT;hypothermia; and a high minute ventilation
How often must HME's be changed? Every 24 hours or prn
What are the hazards of an HME? Underhydration, Secretion buildup in HME, Increased WOB, mucous plugging, increased deadspace, and hypothermia
What is a special consideration of the Heat Moisture Exchanger? It must be removed for administration or aerosol drugs.
What are indications for heating systems? Bypassed airway, hypothermia, airway sensitive to cold air
What are contraindications to heating systems? Airway inflammation
What are some types of heating elements? Hot plates, wrap around heaters, yolk or collar heating elements, immersion heaters
What are some hazards to heating systems? Overheating the airway or humidifier system.
What should always be monitored with the heating systems? The water level and the temperature
What are two hazards of humidity therapy? Condensation Infection Risk/Cross contamination
Condensation Disrupts or occludes the gas flow. It can be aspirated. Is an infection risk.
Infection risk/cross contamination monitor handling of devices use disposible equipment use automatic feed reservoirs Avoid contamination with the floor and trash can. Change circuit as required/needed
What are some ways to ensure adequate gas conditions? Use hygrometer to monitor humidity levels. Monitor temperature. Monitor water levels.
What are aerosols?
What are some examples of aerosols? Liquid, smoke, dust, fog, pollen
Bland aerosol therapy is a form of humidity therapy where solutions are aerosolized. (saline, sterile H20)
What is a device that creates an aerosol? A nebulizer
What are indications for bland aerosol therapy? bypassed airway treatment of upper airway inflammation sputum induction
What are the two types of nebulizers? large volume jet nebulizer ultrasonic nebulizer
How is the large volume jet nebulizer powered? Pneumatically
Some facts about the jet volume nebulizer It can be heated and is very efficient It usually runs continuously
What is a large volume jet nebulizer used with? Aerosol mask, face tent, trach collar, Briggs adaptor, oxygen tents and oxygen hoods
What must you use to power this? An adequate flow rate.
What does the large volume jet nebulizer contain? A baffle to break up H20 particles and an Fi02 control
How is the ultrasonic nebulizer powered? With electricity
What are some facts about the ultrasonic nebulizer? It is not heated It should only be used intermittently It is used with the same devices as large volume jet nebulizer. It can also be used as a room humidifier
What are some risks to the ultrasonic nebulizer? overhydration and bronchospasm
How does the ultrasonic nebulizer work? It uses a piezoelectric crystal to convert electrical energy into sound waves.
How is particle size controlled? It is controlled by frequency for uniform particle size but the output is controlled by the therapist.
The ultrasonic nebulizer only provides? Room air
What are some hazards of bland aerosol therapy? Infection risk/cross contamination Environmental issues (TB) Swelling secretions (overhydration) Bronchospasm Overhydration Noise Condensation Overheating when using a heater
What is the goal of aerosol drug therapy? To deliver a therapeutic dose of a selected agent to the desired site of action
What are the benefits of aerosol drug therapy? Targets the site of action High therapeutic index (very effective/fewer systemic side effects)
List some categories of aerosol drugs. Bronchodilators Steroids Mucolytics Antibiotics
Created by: kparkerlehman