Heated Humidification

* Practicum Goal: * Prevent further complications in respiratory distress by educating the nurse on the use of CPAP and BiPAP to support the patient population with acute respiratory distress and other chronic respiratory illness.

Positive airway pressure could be a safer alternative. However, since we are talking about children they may not leave a CPAP in place. Trying to use nebulizer treatments, mucolytics, inhalers or even oxygen therapy, could assist in a better outcome than the risk of injury by performing CPT.

18 study data were derived from the apnea database (PhysioNet) corresponding to MIT/BIH database. AirFlow, SaO2, Abdominal and Thoracic Movements were obtained from full PSG records. Each record includes a period of nearly eight hours and signals annotation is done minute-by-minute. A minute is labeled as an apnea case if it contains at least one condition of apnea or hypopnea, otherwise labeled as a non-apnea. The patients mean age and weight are between 27 to 63 years (4810.8) and 53 to 135 kg (86.322.2), respectively. PhysioNet data are classified in two categories: Apnea Group (Class A, more than 100 minutes of apnea, mean age: 50 years in range of 29 to 63 years) and Normal Group (class C, less than 5 minutes of apnea, mean age of 33 years

The consequences of undiagnosed and untreated OSA are medically serious and economically costly. Continuous positive airway pressure (CPAP) is considered the gold standard of treatment for OSA along with lifestyle modifications. With CPAP use, patients can reduce their healthcare utilization and save money by reducing the impact of OSA symptoms, comorbidities, and motor vehicle accidents. Direct costs associated with comorbidities include increased medical expenses, emergency room visits, hospital inpatient visits, medication use, and mortality rates (American Academy of Sleep Medicine, 2016).

The project aim was to propose the adaptation of a humidification device to offer comfort to patients who are on high flow oxygen therapy; and to provide in-service trainings to clinical staff. Fisher & Paykel humidifiers were chosen in the proposal as the company provides excellent support for staff; and my past experience has assured me that the equipment is reliable and simple to use for nurses.

Dimich-Ward, Helen, PhD; Michelle Lee Wymer, BSc; and Moira Chan-Yeung, MB. “Respiratory Health Survey of Respiratory Therapists” CHEST; Oct2004, Vol. 126 Issue 4, p1048-1053,

The rationale for this intervention is that humidification can help to thin tenacious secretions, lower the risk of mucus plug formation and allow for better expectoration and easier extraction via suctioning (Branson, 2007). This is particularly relevant for patients with tracheostomies since air entering their lungs is not warmed by the nasal turbinates and can lead to dry secretions that are hard to remove (Lewis, 2014). To implement this intervention I consulted the patient’s chart to confirm that this was recommended. I then attached the patient’s tracheostomy mask to a constant flow of warm humidified

The first assessment I performed for my patient, C.P., was during a day shift on February 23, 2016. Upon receiving her into my care at approximately 0730hrs, I noticed that she was extremely difficult to rouse awake as she was drowsy and could not seem to keep her eyes open. On top of this, she was exhibiting unusually slow respirations while laying supine on her bed, with many blankets around her. For the purpose of this paper, I will be focusing on my respiratory assessment. During this event, performing a thorough respiratory assessment was challenging because C.P. was unable to fully participate due to her current cognitive state.

Sleep apnea, which involves breathing that’s interrupted during sleep, is a severe sleep disorder that affects 22 million Americans. Breathing can be interrupted as much as hundreds of time, which causes the brain, as well as other areas of the body, to not receive enough oxygen. One way to treat this sleep disorder is by using CPAP (continuous positive airway pressure) therapy. This entails using a machine that delivers air pressure through a mask that’s been placed over a person’s nose while sleeping.

Sleep apnea was also a topic in this chapter that caught my attention. My father was diagnosed with sleep apnea a few years ago and it was pretty scary to learn this could block his airway and stop him from breathing. Thankfully there are at least some preventive measures for the short and long term. When he was first diagnosed he was given a machine that helps sustain pressure for airways so that they do not collapse. This is mentioned in our text as "continuous positive airway pressure(CPAP)" therapy that uses a device "that increases air pressure in the throat so the airway remains open"(p. 155).

The concept of long term mechanical ventilation has two clinical aspects: Mandatory; which is use during true life support and elective; which is use to manage patients with chronic ventilator failure and sleep apnea. In mandatory base, invasive approach is the most common (Tobin, 2006). However, home mechanical ventilation (HMV) can be delivered by either invasive or noninvasive route of ventilation. In some centers, if the need for HMV use exceeds 16-20 hours per day, the change to invasive mechanical ventilation will be considered. In general, the use of non-invasive ventilation (NIV) is more preferred than the use of invasive route of ventilation (M. Laub, Berg, & Midgren, 2006). Noninvasive technology is easy to be learned and to be used by the patients and the family and it needs less professional presence on the care site, these problems could be solved now a day with the implementation of telehealth care system which supports and monitors patients and families at home (Goldberg, 2002).

One issue faced daily in primary care is the incidence of hypertension. This disease impacts approximately 25% of the adult population in the world. Risk factors for hypertension include genetics, poor diet, obesity, sedentary lifestyle, and other disease processes. In addition, obstructive sleep apnea (OSA) has been recognized as an additional risk factor in the development of hypertension according to European and US guidelines (Pepin et al, 2014). According to Ohio State physicians Magalang and Valentine, (2015), there are possibly ten million people who have resistant hypertension, and most of those have OSA. In contrast, the National Sleep Foundation explains that sleep apnea affects more than 18 million people (Sleepapnea.org, n.d.). These numbers are staggering. A diagnosis of obstructive sleep apnea increases a patient’s chances of developing hypertension. With this information in mind, it is prudent to recognize the correlation between treating obstructive sleep apnea with CPAP therapy and the benefits of this therapy in regards to blood pressure.

The effects of these treatments are very compelling. “The physiological effects of CPAP include augmentation of cardiac output and oxygen delivery, improved functional residual capacity and respiratory mechanics, reduced effort in breathing, and decreased left ventricular afterload” (Peter, Moran, Phillips-Hughes, Graham & Bersten, 2006). Patient compliance with these devices is an issue and has lead to advances in equipment and function. An example is the recent addition of expiratory pressure relief that helps the patient overcome the feeling of not being able to exhale. ASV has the most complex functioning algorithm, it is able to predict impending respiratory changes and make adjustments to the applied pressures automatically.

Tanya has returned two months since the last appointment. During that time, she underwent a cardiopulmonary exercise test that revealed reduced ventilatory reserve, but an appropriate heart-rate response and no exertion oxygen desaturation. This is consistent with her exercise limitation being due to the mild airflow obstruction. She also underwent a CPAP implementation study that revealed good control of the obstructive events a 8cmH2O, but increasing central events (ie; complex sleep apnoea) with increase in pressures. Tanya has been using CPAP for the last three weeks in auto-set mode and this has led to some improvement in sleep quality and daytime symptoms.

When T-tube and CPAP were compared in the Study (108), it showed that use of T-tube did not impair arterial oxygenation. Further it showed that extubation with T-tube could be superior to CPAP when the pattern of change in PaO2/FiO2 was taken into consideration to predict extubation outcome. The PaO2/FiO2 showed an initial decline and then increasing trend in case of T-tube whereas it had a declining trend in CPAP group. Study by Cekmen N et al. had contrary result showing the number of unsuccessful weaning being higher in T-tube group as compared to CPAP group. However the hemodynamic parameters and arterial blood gases analysis was comparable within and in between CPAP and T-tube group (113).