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Aerosol Drug Therapy
Humidity and Bland Aerosol Therapy
| Question | Answer |
|---|---|
| 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
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