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CPAP and Humidification Therapy Peggy Powers, RRT Clinical Education Fisher and Paykel Healthcare.

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Presentation on theme: "CPAP and Humidification Therapy Peggy Powers, RRT Clinical Education Fisher and Paykel Healthcare."— Presentation transcript:

1 CPAP and Humidification Therapy Peggy Powers, RRT Clinical Education Fisher and Paykel Healthcare

2 Conflict of Interest Disclosure(s) I do not have any potential conflicts of interest to disclose




6 Environment

7 Demographics/Climate Desert Ocean Altitude Swamp Jungle

8 Background to Humidification

9 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

10 Absolute Humidity (AH) 30 mg 30 mg/L Absolute Humidity 15 mg/L Absolute Humidity 15 mg 1L mgH 2 O/L is usually referred to as mg/L

11 Relative Humidity (RH) 30 mg 1L % = content/capacity x % Relative Humidity 15 mg 30 mg 100% Relative Humidity

12 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

13 Dew Point The temperature at which water vapor begins to condense –Cooling process Here, the gas is fully saturated i.e. 100% Relative Humidity

14 15 °C 2% RH 0.3 mg/L 37 °C 100% RH 44 mg/L 40 °C 86% RH 44 mg/L 22 °C 100% RH 20 mg/L AH, RH & Dew Point

15 Humidification & the Upper Airway

16 Anatomy of the Airway Naso-pharynx Oro-pharynx Trachea Gross anatomy of the airway Three main regions: Naso-pharynx Oro-pharynx Trachea

17 Anatomy of the Nasal Passage

18 Inspiration 22 °C Room Air 7 mg/L, 35% RH 31 °C Naso/Oropharynx 30 mg/L, 90% RH 36 °C Trachea 42 mg/L, 100% RH 37 °C Isothermic Saturation Boundary 44 mg/L, 100% RH

19 Normal Airway Inspiration Cilia cell Cilia Mucus Blood vessel

20 Expiration 33 °C 30 mg/L, 85% RH 75% of the heat and moisture is lost to the environment1,2 The majority of the recovery (25%) is in the naso- and oro- pharynx 1 Ingelstedt, 1956; 2 Cole, 1954

21 Cilia cell Cilia Mucus Normal Airway - Expiration

22 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

23 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.

24 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

25 Available Humidification Technologies

26 No humidity Cold pass-over Conventional heated humidification Heated breathing tube Humidification Delivery Modes

27 No Humidification

28 Effects of No Humidification

29 Cold Pass-Over Humidification An interim treatment for patients who complain of nasal symptoms after initiation of CPAP Passing of cold air over water

30 Effects of Cold Pass-over

31 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

32 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

33 Limitations of Conventional Heated Humidification Ambient air temperature Condensation Disruptive noise leading to fluctuating mask pressure

34 Condensation – Conventional Humidification TUBE COOLING = CONDENSATION BUILD UP = PATIENT DISRUPTION 30 o C 29 mg/L 20 o C 17 mg/L

35 Bacon et al, 2000 Condensation

36 Copper wire coiled inside breathing tube Discounts the effects of changing ambient temperature Operates in its own controlled environment Heated Breathing Tube (HBT)

37 Conventional vs HBT 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

38 HBT Clinically Proven for A Better Nights Sleep

39 FPH 40 years of experience in humidification technology 5 years of global ThermoSmart market experience Dedicated research program THE ORIGINAL HEATED BREATHING TUBE ThermoSmart

40 ThermoSmart combines several key technologies to deliver high (physiological) levels of humidification: –A Heated Breathing Tube retains heat along the tube ensuring the intended level of humidity reaches the mask and patient, as well as working to prevent condensation –A temperature sensor monitors and responds to room temperature to prevent condensation –A flow sensor identifies mouth leak and increases humidity to compensate –A high-capacity power supply generates humidity on demand –A large-capacity water chamber ensures lasting humidity delivery No other HBT has the same advanced technology WHAT IS THERMOSMART TM ? HBT

41 Sensors & algorithms in place of RH and EOH sensors

42 The Best Humidification System After one hour stabilization period. Room conditions 50% RH and 23 ºC (74 ºF)

43 Proven Clinical Research


45 Clinical Summary

46 End

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