the science of hmes
TRANSCRIPT
81April 1 2015
72April 1 2015
63April 1 2015
54April 1 2015
45April 1 2015
36April 1 2015
bullthomidin
7 April 1 2015
The First Artificial Nose
8 April 1 2015
The Science of HMEs
AARC ndash CRCE Course
Steve Koontz
10 April 1 2015
11 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
72April 1 2015
63April 1 2015
54April 1 2015
45April 1 2015
36April 1 2015
bullthomidin
7 April 1 2015
The First Artificial Nose
8 April 1 2015
The Science of HMEs
AARC ndash CRCE Course
Steve Koontz
10 April 1 2015
11 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
63April 1 2015
54April 1 2015
45April 1 2015
36April 1 2015
bullthomidin
7 April 1 2015
The First Artificial Nose
8 April 1 2015
The Science of HMEs
AARC ndash CRCE Course
Steve Koontz
10 April 1 2015
11 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
54April 1 2015
45April 1 2015
36April 1 2015
bullthomidin
7 April 1 2015
The First Artificial Nose
8 April 1 2015
The Science of HMEs
AARC ndash CRCE Course
Steve Koontz
10 April 1 2015
11 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
45April 1 2015
36April 1 2015
bullthomidin
7 April 1 2015
The First Artificial Nose
8 April 1 2015
The Science of HMEs
AARC ndash CRCE Course
Steve Koontz
10 April 1 2015
11 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
36April 1 2015
bullthomidin
7 April 1 2015
The First Artificial Nose
8 April 1 2015
The Science of HMEs
AARC ndash CRCE Course
Steve Koontz
10 April 1 2015
11 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
bullthomidin
7 April 1 2015
The First Artificial Nose
8 April 1 2015
The Science of HMEs
AARC ndash CRCE Course
Steve Koontz
10 April 1 2015
11 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
The First Artificial Nose
8 April 1 2015
The Science of HMEs
AARC ndash CRCE Course
Steve Koontz
10 April 1 2015
11 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
The Science of HMEs
AARC ndash CRCE Course
Steve Koontz
10 April 1 2015
11 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
10 April 1 2015
11 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
11 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
12 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
13 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
14 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
15 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
16
Inhalation Therapy
April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
17
Treatment for Respiratory Ailments Were Common During the Late 1800s
April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Compound Oxygen
ldquoScientific adjustment to oxygen and nitrogenrdquoDrs Starkey and Palen 1888
18 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
19 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
20
Compound oxygen was not oxygen but a very dilute laughing gasrdquo made by heating ammonium nitrate
April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
21 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
22 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
The American Association of
Inhalation Therapy
The University of Chicago Hospital establishes the
Inhalation Therapy Association
in 1946
23 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
24 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
An Early Oxygen Tank
25 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
26 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
27 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
28 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
29
When providing passive humidification to patients
undergoing invasivemechanical ventilation it is
suggested that the HME provide a minimum of 30 mg H2OL
April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Clinical Practice GuidelinesDuring Mechanical Ventilation
30 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
31 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
32 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
33 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
34 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
35 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Advantages of Using Active HumidifiersDuring Mechanical Ventilation
36 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
Temperature setting is not humidity delivered
Costly possibilities of malfunction and down time
User problems as reported in MAUDE ndash
FDA - Manufacture and User Facility Device Experience
37 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Disadvantages of Using Active HumidifiersDuring Mechanical Ventilation
May develop condensation within the circuit
Possible infectious waste (biological hazard)drainage into heater reservoir the ventilator onto practionerrsquos face and more
Complex to use with over or under hydration possible
May not produce as much humidity as thought
38 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Secretions = Biological Hazard
39 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Secretions = Biological HazardEven from the circuit
40 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Heated Humidifiers
41 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
42 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
43 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
44 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
What is an Artificial Nose
45 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
The Artificial Nose
46 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
47 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
The Artificial Nose
48 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Humidification During Mechanical Ventilation
49 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Humidification During Mechanical Ventilation
50 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Humidification During Mechanical Ventilation
51 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Humidification During Mechanical Ventilation
52 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Humidification During Mechanical Ventilation
53 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Humidification During Mechanical Ventilation
54 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Advantages of Using Passive Humidifiers
55 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Advantages of Using Passive Humidifiers
56 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Disadvantages of Using Passive Humidifiers
57 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Disadvantages of Using Passive Humidifiers
58 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Advantages of Using Active HME Humidifiers
59 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Disadvantages of Using Active HME Humidifiers
60 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
All ldquoNosesrdquo Are Not Alike
61 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
US Department of Health and Human ServicesMAUDE - Manufacturer and User
Facility Device Experience
62 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
63
What is 3030
April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
64
3030
April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
65 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
66
bull heat and moisture exchanger
HME
bull filter heat and moisture exchanger
FHME
April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
67
bull hygroscopic condensing humidifier
HCH
bull filter hygroscopic condensing humidifier
FHCH
April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
68
bull gas flow may be redirected to and around the media
Bypass HME
bull heat and water added to the HME
Active HME
April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
69
Hygroscopic
The ability of a substance to attract and hold watermolecules from the surrounding environment byenhancing the natural physical properties
This is achieved through either
absorption oradsorption
with the material becoming physically changedrdquo
April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
70
Absorption Incorporation of moisture This moisturebecomes a part of the media
(gray arrows)
Adsorption Adhesion of moisture to a surface(blue arrows)
April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Coffee Pour Test
71 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Coffee Pour Test
72 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Examples of Passive and Active HMEs
73 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Examples of Passive Humidifier Designs
74 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Examples of Passive Humidifier Designs
75
Many flex tubes will add about 2 mg of moisture
April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Examples of Trach Passive Humidifier Designs
76 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Examples of Humidification Media
77 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
78 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
79 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Replaced HMEq 24 hours
Bloody secretions Thick tenacious sputum
Less than 70 Core temp less 320 C
Evaluate secretion quality and quantity
Examine patient
Use heated humidification
Examine patientrsquosHxPx
More than 4 HMEs used in 24 hours
NO
YES
YES
NO
80
Humidification for Patients with Artificial Airways RESPIRATORY CARE JUNE 1999 VOLUME 44 NO 6 page 638
April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
InconsistentTherapyPassivehumidifiersandinaccurateactivehumidificationsettingsmayleadtoundesirablesputumoutcomesendotrachealtubeocclusionsandorpneumothorax
Practioner replaces HME and perceives everything to be ok
81 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Donrsquot be Fooled The 3Cs
82 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
83 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Donrsquot be Fooled The 3Cs
84 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
ldquoChargingrdquo -- Function of Media
85
Secretions cover the material
April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
86 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
87 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Donrsquot be Fooled The 3Cs
88 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Too Late to Check Effectiveness
89 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Donrsquot be Fooled The 3Cs
90 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Collectinghellip
91
gas in gas in
gas out
April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
The 3Cs
92 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Should PH be Chosen Based Upon Minute Ventilations amp Moisture Delivered
93 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
How Do I Know My PatientIs Being Humidified
94 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
95 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
96 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Assessment of Sputum Characteristics
97 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Sputum Descriptions
98 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
99 April 1 2015
Honk Honk
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Research Independent Documentationof Effectiveness
100 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
101
This patient was featured on The Learning Channel
2nd and 3rd degree burns over 60 of the body
and 3 months LOS (tracheal not comprised)
Only this HCHF was used to humidify the patient
Used with permission
April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
MHRA amp UK Medicines Healthcare Products
102 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
103
Richard Bransonrsquos evaluation of 21 HMEs Table 2 (Respir Care 1996 41736-743)
April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Documentation of PH Effectiveness
104 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
MAUDE Adverse Event Report
105 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
MAUDE Adverse Event Report - Passive
106 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
MAUDE Adverse Event Report - Passive(page 2)
107 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
MAUDE Adverse Event Report - Active
108 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Early Coffee Cups
109 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
What to Look For When Choosing a PH
110
April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Most Important Features of PH
111
Filter
Cost
Resistance
Moisture output
Dead space
Design
Respiratory Care June
1999 Vol 44 No 6 Pg 636
April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
ldquoOur findings suggest that the initial application of an extended-use hygroscopic condenser humidifier (HCH) is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidificationrdquo
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
112 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
Is Our Goal Today
Revisiting- Reviewing- Rethinking- our Methods
Irsquom outta here
114 April 1 2015
114 April 1 2015