HUMIDIFICATION

 Humidification is a method to artificially condition

the gas used in respiration of a patient as a
therapeutically modality.
 Active method is by adding heat or water or both
to the device or passive which is recycling heat
and humidity which is exhaled by the patient.
INDICATIONS
Primary Secondary
 Overcoming humidity  To manage
deficit (upper airway hypothermia
bypass)  To treat bronchospasm
 To humidify dry (due to cold air)
medical gasses
Clinical signs and symptoms of
inadequate humidification
 Dry and non-productive cough
 Atelectasis
 Increased airway resistance
 Increased work of breathing
 Increased incidence of infection
 Thick and dehydrated secretions
 Complaints of substernal pain
and airway dryness
 Physiology
 Heat and moisture exchange is a primary function of
the upper respiratory tract, mainly the nose.
 The nasal mucosal lining is kept moist by secretions
from mucous glands, goblet cells, transudation of fluid
through cell walls, and condensation of exhaled
humidity.
 As the inspired air enters the nose, it warms
(convection) and picks up water vapor from the moist
mucosal lining (evaporation), cooling the mucosal
surface.
Physiology cont
 Condensation occurs on the mucosal surfaces during
exhalation, and water is reabsorbed by the mucus
(rehydration).
 The mouth is less effective at heat and moisture exchange
than the nose because of the low ratio of gas volume to moist
and warm surface area and the less vascular squamous
epithelium lining the oropharynx and hypopharynx.
Principles of humidifier function
 Temperature – As the temperature of a gas increases, its
ability to hold water vapour (capacity) increases and vice
versa.
 Surface area – There is more opportunity for evaporation to
occur with greater surface area of contact between water and
gas.
 Time of contact – There is greater opportunity for evaporation
to occur, the longer a gas remains in contact with water.
 Thermal mass – The higher the mass of water or core element
of a humidifier, the higher its capacity to transfer or hold heat.
Method of humidification
Methods
 Systemic hydration
 Heated water bath humidifier
 Heat & moisture exchange
 Large volume jet nebulizers
 Ultrasonic humidifier
 Bubble through humidification
 Passover humidifier
Heat and moisture exchange (HME)
 Known as ‘Swedish nose’
 Light weight disposal device
 Used with mechanical ventilator or
breathing spontaneously
 Similar to nasopharynx
 It function without the additon of a
water source or electricity.
 It collects and conserves the patient’s
expired moisture and heat.
 Considered to be passive humidifier
 Traps heat and humidity in expired gas
 Has been used to provide humidity for
spontaneously and mechanically ventilated
patients
 With a filter for bacteria and viruses it become
Heat and Moisture Exchanging Filter (HMEF)
 Types of HMEs:
 simple condenser humidifiers
 Hydrophobic
 hygroscopic
Simple condenser Hygroscopic heat Active Heat Moisture
humidifier exchanger Exchangers
 Contains condenser  Uses condenser  Add heat or humidity
element to trap heat and element made of (or both) to inspired
humidity of expired gas paper, wool, or foam gas
 Retains about 50% of  Material includes a salt  External heat and
expired heat and  Maximum absolute moisture is introduced
humidity humidity is 22 to 34 into inspired gas
 Maximum absolute  Capable of providing
mg/L
humidity is 18 to 28 100% relative
mg/L humidity.
Hydrophobic
 Hydrophobic membrane with
small pores
 Membrane is pleated to increase
the surface area
 provides moderately good
inspired humidity
 May be impaired by high
ambient temperatures
 Efficient bacterial and viral
filters
 Prevent the HCV from passing
 Allow the passage of water
vapor but not liquid water at
usual ventilatory pressure
 Associated with small increases
in resistance even when wet
Hygroscopic
 Contain a wool/foam/paper like
material coated with moisture-retaining
chemicals
 Medium may be impregnated with a
bactericide
 Composite hygroscopic HMEs – a
hygroscopic layer plus a layer of thin,
nonwoven fiber membrane that has
been subjected to an electrical field to
increase its polarity -- improves
filtration efficiency and
hydrophobicity.
 Composite hygroscopic HMEs are
more efficient than hydrophobic ones
 Lose their airborne filtration efficiency
if they become wet; microorganisms
held by the filter medium can be
washed through the device
 Their resistance can increase greatly
when wet
Type Hygroscopic Hydrophobic

Heat and moisture exchanging Excellent Good

efficiency
Effect of increased tidal volume on Slight decrease Significant decrease
heat and moisture exchange
Filtration efficiency when dry Good Excellent

Filtration efficiency when wet Poor Excellent

Resistance when dry Low Low

Resistance when wet Significantly increased Slightly increased

Effect of nebulized medications Greatly increased Little effect

resistance
Bubble through humidification
 Gas passes through
tube to bottom of
water reservoir
 Gas bubbles through
reservoir
 Unheated bubbles
through humidifier
 Provides humidity for
oxygen therapy
Passover humidifier
 Direct gas over liquid or over surface
saturated by liquid
 Types:
 Simple reservoir model
 Wick units
 Membrane devices
 Simple reservoir
 Gas flows over surface of volume of water
 Usually used as heated system to provide
humidity to mechanically ventilated
patients
Systemic hydration
 Increase the amount of fluid intake orally or
intravenous
 To keep our body from dehydrated
 To avoid air way secretion become more tenacious
Hazards
 Inhalation of cold mist or water may cause
bronchoconstriction in patients with hyper reactive
airways.
 Water reservoirs – good culture medium for
bacteria – increase risk of infection – regular
disposal, disinfection or sterilization of all
equipment is must.
NEBULIZATION
 Nebulization is means of administering drugs by
inhalation.

 Liquid Nebulisation is a common method of medical

aerosol generation.

 A nebuliser is a device that converts liquid into aerosol

droplets (fine mist) suitable for inhalation.

 Nebulisers use oxygen, compressed air or ultrasonic

power to break up medication solutions and deliver a
therapeutic dose of Aerosol particles directly to the
lungs.
Indications
 Delivery of bronchodilator drugs : On acute
attack of asthma Nebulization is the most common
means of delivery.
 Administration of antibiotics and anti antifungal
agents: In some cases of resistant chest infections
for eg.cystic fibrosis antibiotics may be prescribed
to be inhaled directly into the lung.
 To aid expectoration : Inhalation of hypertonic
saline has been found to increase clearance of
bronchial secretions.
 Local analgesia: To relieve dyspnea in patients
such as those suffering from alveolar carcinoma.
Contraindications
 Insome cases, nebulization is restricted or avoided
due to possible untoward results or rather
decreased effectiveness such as:
 Patients with unstable and increased blood pressure
 Individuals with cardiac irritability (may result to
dysrhythmias)
 Persons with increased pulses
 Unconscious patients (inhalation may be done via
mask but the therapeutic effect may be significantly
low)
Ideal Nebulizer
 A minimum residual volume(< 0.5 ml)
 Aerosol delivered only during inhalation.
 No waste aerosol released to the environment.
 Small and portable.
 Aerosol delivered with a droplet size distribution
suitable for pulmonary deposition.
 Rapid treatment time, quite and unobtrusive in use.
 Finally,perhaps also a means to monitor patient
compliance.
 Particle size
 Massmedian aerodynamic
diameter
 ≤ 1μm : Reach up to the
alveoli,
 0.5-5μm: Beyond the 10th
generation of bronchi
(respirable particles),
 ≥ 5 μm : oropharynx
Nebulizers
 Solution or suspensions can be nebulized by ultrasonics
or an air jet and administered via a mouthpiece,
ventilation mask or tracheostomy.

 Types of nebulizers :
 Jet nebulizer
 Ultrasonic wave nebulizer
 Vibrating mesh Nebulizers
 Air jet Nebulizer
 In air jet nebulizer compessed air is
forced through an orifice, an area of
low pressure is formed where the air jet
exists.
 A liquid may be withdrawn from a
perpendicular nozzle (the Bernoulli
effect) to mix with the air jet to form
droplets.
 A baffle within the nebulizer is often
used to facilitate the formation of the
aerosol cloud.
 Carrier gas (oxygen) can be used to
generate the “air jet”.
 Jet nebulizers are the most commonly prescribed because they are
easy to use and inexpensive.

Disadvantages:
 Less portable than inhalers
 Delivery may take 5 to 10 mins or longer.
 Require power sources, maintanance, cleaning.
 Traditional jet nebulizers are often bulky and require an electrical
source, which can be a problem intraveling.
 Noisy
Breath-Enhanced Jet Nebulizers
 Continuous gas flow to neb chamber combined
with patients inspired air.
 Exhaled air does not mix with aerosol, amount of
solution wasted is minimized.
ADVANTAGES DISADVANTAGES

 High output ,short  Cannot be used in

treatments. ventilator circuits.
 Higher dose than T-Neb  Not cost effective for
or MDI is possible. short term use.
 Multiple one –way  Not readily adaptable
valve reduce waste. to tracheostomy masks.
 Dishwasher safe, may
be boiled or autoclaved
 Cost effective for long -
term
 Ultrasonic Nebulizer
 Ultrasound waves are formed in an ultrasonic nebulizer chamber by
a ceramic piezoelectric crystal that vibrate when electrically excited.
 These set up high-energy waves in the solution, within the device
chamber ,of a precise frequency that generates an aerosol cloud at
the solution surface.
 Ultrasonic nebulisers (i.e. aerosonic nebulisers) are
characterised by fast nebulisation of medicine particles
into extra small size for enhanced absorption in the very
depth of the respiratory system, helping to increase the
effects of medication.
 Ultrasonic nebulisers are fast and discreet with reduced
noise levels.
 They can be used at home and during travel as many
modern ultrasonic nebulisers are not only mains powered,
but also battery powered for convenience.
 Car adaptors are also used for nebulisation on the move or
for recharging batteries.
 The only drawback is medication restrictions because heat
is transferred to the medication
Vibrating Mesh Nebulizer
 In this technology a mesh/membrane
with 1000-7000 laser drilled holes
vibrates at the top of the liquid
reservoir, and thereby pressures out a
mist of very fine droplets through the
holes.

 This technology is more efficient

than having a vibrating piezoelectric
element at the bottom of the liquid
reservoir, and thereby shorter
treatment times are also achieved.
 The high nebulization capacity (>0.25 ml/min) device
offers short inhalation time.

 The old problems found with the ultrasonic wave

nebulizer, having too much liquid waste and undesired
heating of the medical liquid, have also been solved by
the new Vibrating Mesh nebulizers.
 New Generation Nebulizer
 AERx
 Advantages of the AERx System
 Small hand-held devices
 Very short administration
time(typically 1-2 breaths)
 Highly efficient, precise aerosol
delivery
 Breath control to ensure reliable
drug delivery to lung
 Simple to use.
Nebulizer Solution Formulations
 Nebulizers are designed primarily for use with aqueous
solution or suspension.
 Drug suspension use primary particles in the range of
2-5 microns.
 Nebulizer solutions are usually formulated in water,
although other cosolvent for eg. Glycerin, propylene
glycol,and ethanol may be used.
 Nebulizer solution pH be greater than 5.0 to show that
bronchoconstriction is a function of hydrogen ion
concentration.
Method of Administration
 Nebulized aerosol is introduced to the patient by
compressed air from a device known as positive pressure
ventilator.

 A mouthpiece may be inserted in the mouth may be

attached tightly to the face.

 A face tent fits more loosely around the patients

mouth,allowing speech.

 A tracheostomy mask may be fitted to the patients

tracheostomy tube directly and require T shaped adapter.
 Face masks should be avoided or sealed very tightly
when anticholinergic drugs are administered to patients
with glaucoma.
 Face masks should ideally also be avoided for delivery
of nebulized corticosteroids, to prevent contact with the
surrounding facial skin and eyes.
Practical Issues
 Cleaning :
 Nebulizers should be cleaned daily in regular usage and
after each use in intermittent use.
 The mask, mouthpiece and chamber should be disconnected,
disassembled and washed in a warm detergent and water
solution. The components should be left to dry overnight.
 Before reuse, the nebuliser should be run for a few seconds
before adding medications.
 Maintenance :
 Disposable components such as the mouthpiece, mask,
tubing and nebulizer chamber should be changed every three
to four months.
 Compressors require annual servicing by manufacturer or
local service provider.