cpap and humidification therapy peggy powers, rrt clinical education fisher and paykel healthcare
TRANSCRIPT
CPAP and Humidification Therapy
Peggy Powers, RRTClinical EducationFisher and Paykel Healthcare
Conflict of Interest Disclosure(s)
I do not have any potential conflicts of interest to disclose
MY CPAP GAVE ME A COLD!
Environment
Demographics/ClimateDemographics/Climate
• Desert• Ocean• Altitude• Swamp• Jungle
Background to Humidification
Background to Humidification
What is Humidity?
• Humidity is the amount of water vapor in a gas
• Describing humidity
– Absolute Humidity
– Relative Humidity
• Key humidity concepts
– Maximum Capacity
– Dew point
Absolute Humidity (AH)
30 mg
30 mg/L Absolute Humidity
15 mg/L Absolute Humidity
15 mg
1L
• mgH2O/L is usually referred to as mg/L
Relative Humidity (RH)
30 mg 30 mg
1L
• % = content/capacity x 100
50% Relative Humidity
15 mg 30 mg
100% Relative Humidity
Maximum Capacity
15 mg/L
17 mg/L
19 mg/L
22 mg/L
24 mg/L
27 mg/L
18 ºC 20ºC 22 ºC 24 ºC 26 ºC 28 ºC 30 ºC
30 mg/L
Dew Point
• The temperature at which water vapor begins to condense – Cooling process
• Here, the gas is fully saturated i.e. 100% Relative Humidity
Humidification & the Upper Airway
Anatomy of the Airway
Naso-pharynx
Oro-pharynx
Trachea
•Gross anatomy of the airway
•Three main regions:
• Naso-pharynx
• Oro-pharynx
• Trachea
Inspiration
22 °CRoom Air
7 mg/L, 35% RH
31 °CNaso/Oropharynx30 mg/L, 90% RH
36 °C Trachea
42 mg/L, 100% RH
37 °CIsothermic Saturation
Boundary44 mg/L, 100% RH
Nasal Symptoms
• The airway is a natural heated humidifier
• A constant flow of air delivered via CPAP can dry the nasal mucosa
• Excessive drying of the nasal mucosa increases nasal resistance, thereby increasing nasal discomfort
• Production of mucus is also increased to help humidify the additional air flow
• These factors can induce symptoms such as nasal congestion
Nasal Congestion
• Nasal congestion is a narrowing/blockage of the nasal passages
• It is usually due to membranes lining the nose becoming swollen from inflamed blood vessels.
• Nasal congestion is also known as nasal obstruction, blocked nose, runny nose, or stuffy nose.
Nasal Symptoms
• Nasal symptoms can be alleviated by the use of a humidifier with your CPAP
• When the flow of air is already humidified this reduces the demand on the bodies natural humidification system
Available Humidification Technologies
• No humidity
• Cold pass-over
• Conventional heated humidification
• Heated breathing tube
Humidification Delivery Modes
No Humidification
Effects of No Humidification
Cold Pass-Over Humidification
• An interim treatment for patients who complain of nasal symptoms after initiation of CPAP
• Passing of cold air over water
Effects of Cold Pass-over
• Heating the water filled chamber using a heater plate
• Air passing over the heated water adds moisture and humidifies the delivered air
• Turbulence induced in the chamber helps pick up humidity
Conventional Heated Humidification
Benefits of Conventional Heated Humidification
1. Alleviates reported nasal discomfort
2. Lowers therapy abandonment
3. Improves patient compliance
4. Reduces the incidence of mouth leak
Limitations of Conventional Heated Humidification
• Ambient air temperature
• Condensation
• Disruptive noise leading to fluctuating mask pressure
Condensation – Conventional Humidification
TUBE COOLING = CONDENSATION BUILD UP = PATIENT DISRUPTION
30 oC29 mg/L
20 oC
17 mg/L
Bacon et al, 2000
Condensation
• Copper wire coiled inside breathing tube
• Discounts the effects of changing ambient temperature
• Operates in its own controlled environment
Heated Breathing Tube (HBT)
Conventional vs HBT
Timeline 2hrs
Timeline 2hrs
TUBE COOLING - CONDENSATE FORMS
WARM TUBE: HEAT LOSS + HEAT GAIN = CONSTANT HEAT
Conventional Humidification
Heated Breathing Tube Humidification
18 mg/L
30mg/L
Conventional
HBT
30mg/L
30mg/L
HBT
Clinically Proven for A Better Nights Sleep
• FPH 40 years of experience in humidification technology
• 5 years of global ThermoSmart™ market experience
• Dedicated research program
THE ORIGINAL HEATED BREATHING TUBE
ThermoSmart™
Sensors & algorithms in place of RH and EOH sensors
Proven Clinical Research
START WITH THERMOSMART™
HBT
Clinical Summary
End