湿化殷彩欣.ppt

To gradients may create differing humidifier inlet gas To, depending on conditions: 27.4oC to 29.8oC when ventilators run at normal ambient air To (23oC) and low minute volumes (10 L/min) 33.4oC to 37.9oC when ambient To is high (29oC) and high minute volumes (20 L/min). A ventilator with a high outlet gas To may cause chamber water loss to be lower than normal. Less condensation will form in the breathing circuit. * suggest that drop lines at least 48 inches long may bring inlet chamber gas temp to near ambient room To. Longer drop lines may be needed to achieve this To decrease. * * May use a flow chart to illustrate sequence of events. Switch bullets 2 and 3 BW: BULLETS SWITCHED * * Aerosol administration may require interruptions in MV and PEEP. Detrimental to the patient as it may compromise alveolar recruitment and increase risk for VAP. To ensure circuit integrity during aerosol therapy, a pMDI spacer is left in the circuit. * Probably due to faster evaporation of propellant at higher temperatures which accelerates delivery rate of small particles.1 * High RH and To in ventilator circuit associated with large reductions of lung deposition. Clinicians often turn off HH before administering aerosols. Failure to turn on after treatment can cause symptoms of inadequate humidification. Turning heater off prior to treatment does not result in greater aerosol drug delivery. This practice should be abandoned. ? Moisture generated from HH has a tendency to accumulate in the circuit and on the pMDI spacer. Condensate accumulation is greatest ~6 hours after connecting the spacer to the circuit. Accumulation can be as high as 5 mL. No significant differences on mass median aerodynamic diameter (MMAD) with dry vs. high RH.1 Higher humidity significantly inhibits reduction in size of aerosolized particles after they leave the pMDI.2,3 * FIG. 3. Effect of humidity on aerosol delivery in patients receiving invasive mechanical ventilation. The mean efficiency