Respiratory care clinics of North America
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Respir Care Clin N Am · Jun 1998
ReviewHumidification practices in the Adult Intensive Care Unit, Prince of Wales Hospital.
In the Adult Intensive Care Unit of The Prince of Wales Hospital, Sydney, Australia, inspiratory gas is humidified to saturation at 37 degrees C. This stops the buildup of dried sputum within the endotracheal tubes and thus prevents blocked tubes and the increased resistance caused by partial obstruction. Inspiratory and expiratory hose heater wires are used to produce a completely dry circuit, allowing the elimination of water traps and circuit support arms without the resistance of a heat and moisture exchanger.
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Nosocomial pneumonia remains an important problem in patients undergoing mechanical ventilation, being associated with high mortality and morbidity and considerable expenditure. In the past respiratory equipment has been implicated in the development of nosocomial pneumonia and strict recommendations for cleaning and maintenance have been practiced. It is now known that the circuit and other equipment rapidly become contaminated with microorganisms originating from the patient's upper airway flora. ⋯ Current evidence suggests that circuit contamination usually is a result rather than a cause of airway colonization and does not have an important role in the pathogenesis of nosocomial pneumonia. Provided that reasonable infection control measures are taken, circuit contamination does not pose a risk to the ventilated patient. Although bacterial filters placed in the circuit effectively prevent circuit contamination they do not significantly reduce the incidence of nosocomial pneumonia in patients receiving mechanical ventilation.
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Humidification during anesthesia is important to prevent adverse changes in the upper airways and possible pulmonary compromise. These changes may take place in less than 1 hour using dry nonhumidified anesthetic gases. Consequently, some method of humidification should be employed for all but the shortest of surgical procedures requiring general anesthesia. ⋯ It may be preferable to have a gas with a lower temperature and higher relative humidity because a warmer gas that is less saturated may result in increased desiccation from the upper airways. Humidification for neonatal and pediatric patients requires special consideration of resistance, work of breathing, and dead space. Further work is necessary with regard to the use of HMEs in this population of patients undergoing general anesthesia.
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The use of heated humidification in adults does not appear to be an important factor in maintaining body temperature in adults. Heat and moisture losses certainly can be reduced with heated humidification, but the contribution to temperature regulation appears small. The use of an HME reduces heat loss form the respiratory tract, but this loss is minute compared with losses from the skin, fluid administration, and the operative site. In neonates, the use of heated humidification during surgery may help contribute to thermal balance owing to the unique issues of temperature regulation and control in these patients.
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Respir Care Clin N Am · Mar 1998
ReviewPulmonary rehabilitation of the patient with nonobstructive lung disease.
Disability from chronic lung disease is usually associated with COPD and pulmonary rehabilitation programs are designed to address this population. There are a number of chronic nonobstructive lung diseases, however, that can produce disability and that also may benefit from pulmonary rehabilitation. This article discusses how to classify nonobstructive lung disease patients and examines their evaluation, rehabilitation, and outcomes.