HYDRATION, HUMIDIFICATION and NEBULISATION
AARC Clinical Practice Guideline: HUMIDIFICATION DURING MECHANICAL VENTILATION (1992) Respir Care, 8, 37, 887890
www.rcjournal.com/cpgs/hdmvcpg.html
AARC Clinical Practice Guideline: BLAND AEROSOL ADMINISTRATION (2003). Respir Care; 48, 529-33
www.rcjournal.com/cpgs/05.03.0529.html
US guidelines on saline nebulisers
AARC Clinical Practice Guideline: DIRECTED COUGH (1993). Respir Care, 38, 5, 4959
www.rcjournal.com/cpgs/dccpg.html
similar to ACBT
Anil AB, Anil M, Saglam AB (2010) High volume normal saline alone is as effective as nebulized salbutamol-normal saline, epinephrine-normal saline, and 3% saline in mild bronchiolitis. Pediatr Pulmonol, 45, 1, 41-47
Blower AC (1997) Is thirst associated with disability in inpatients? J Human Nutr Dietitics. 10, 289-93
www.blackwell-synergy.com/doi/abs/10.1046/j.1365-277X.1997.00061.x
recommended daily fluid intake is 1.5
less than 1/3 of in-patients are able to drink enough, mostly because they can't reach their drink
Botman MJ (1987) Contamination of small-volume medication nebulisers. J Hosp Inf, 10, 204-8
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WJP-4CDHPB5-FY&_user=10&_handle=V-WA-A-W-WU-MsSAYZA-UUA-U-AAWBYYVYBU-AAWAVZCZBU-WWCEEYBZZ-WU-U&_fmt=summary&_coverDate=09%2F30%2F1987&_rdoc=14&_orig=browse&_srch=%23toc%236884%231987%23999899997%23501864!&_cdi=6884&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=3491a856fa40521e1f4bb3dbf43d956b
one third of hospital nebs found to be contaminated
Branson RD (1999) Humidification for patients with artificial airways. Respir Care, 44, 630-41
www.rcjournal.com/contents/06.99/06.99.0630.asp
humidifiers and heat-moisture exchangers
Branson RD et al (1999) Comparision of heated humidification with a new active hygroscopic HME in mechanically ventilated patients. Respir.Care, 44, 912-17.
www.rcjournal.com/contents/08.99/08.99.0912.asp
new HME is as effective as heated humidifier, but adds dead space
Branson RD (2009) Conditioning inspired gases: the search for relevant physiologic end points. Respir Care, 54, 4, 450-2
www.rcjournal.com/contents/04.09/04.09.0450.pdf
HME is associated with risk of ETT obstruction 4 x that of heated humidifier.
choice of humidifier should be based on gas exchange, not moisture output.
Cobben NAM et al (1996) Outbreak of severe Pseudomonas aeruginosa respiratory infections due to contaminated nebulizers. J Hosp Inf, 33, 63-70
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WJP-4C707TR-52&_coverDate=05%2F31%2F1996&_alid=295414472&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=6884&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8af042829b11b457a00a6e438286da11
Pseudomonas isolated in 4 of 22 nebulisers
Conway J, Fleming JS, Perring S et al (1992) Humidification as an adjunct to chest physiotherapy. Respir Med, 86, 109-14
Craven DE, Lichtenberg DA, Goularte TA (1984) Contaminated medication nebulizers in mechanical ventilator circuits. Am J Med, 77, 834-8
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TDC-4BYSNXF-9H&_user=10&_handle=V-WA-A-W-VB-MsSAYZA-UUA-U-AAWBYBYEUY-AAWAVAEDUY-WWVWVACBC-VB-U&_fmt=summary&_coverDate=11%2F30%2F1984&_rdoc=11&_orig=browse&_srch=%23toc%235195%231984%23999229994%23487823!&_cdi=5195&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=655772a6226ca294d44a9a0cffdda148
bacterial aerosol produced by 71% of in-line medication nebulisers
Chiumello D (2008) Effect of a heated humidifier during continuous positive airway pressure delivered by a helmet. Crit Care, 12: R55
ccforum.com/content/12/2/R55
humidification is required with a helmet interface
Gallon AM (1996) Evaluation of nebulised acetylcysteine and normal saline in the treatment of sputum retention following thoracotomy. Thorax, 51, 429-32
thorax.bmjjournals.com/cgi/content/abstract/51/4/429
nebulised acetylcysteine reduces sputum viscosity, making expectoration easier and improving oxygenation
nebulised normal saline has no effect.
Hamill RJ (1995) An outbreak of Burkholderia (formerly Pseudomonas) cepacia respiratory tract colonization and infection associated with nebulized albuterol therapy. Ann Intern Med, 122, 762-6
epidemics of pneumonia caused by contamination of in-line ventilator nebulisers
Jones PD (1985) Microbial contamination of domiciliary nebuliser equipment. Austr N Z J Med, 15, 585-9
one-third of domiciliary nebs contaminated
Joynt GM (1994) The use of heat and moisture exchangers in critically ill patients. Care Crit Ill, 10, 271-4
includes physiology of humidification
Khan SY, ODriscoll BR (2004) Is nebulized saline a placebo in COPD? BMC Pulm Med, 4, 9
www.biomedcentral.com/1471-2466/4/9#B3
saline nebs show some subjective benefit, but references are misquoted
Lane DJ (1991) Chronic persistent asthma. Respir Med, 85, 359-63
domiciliary nebs - bacterial contamination
Lucato JJJ (2005) Evaluation of resistance in 8 different heat-and-moisture exchangers. Resp Care, 50, 636-43
saturation affects resistance in hydrophobic or hygroscopic/hydrophobic models, but not with hygroscopic models
Mandelberg M (2010) Hypertonic saline or high volume normal saline for viral bronchiolitis: mechanisms and rationale. Pediatr Pulmonol, 45, 1, 36-40
Pilbeam SP (2000) Mechanical Ventilation, Mosby, Missouri.
greater risk of infection from ventilator nebulisers than with hot water humidifiers because organisms can be carried in droplets but not vapour
Rea H, McAuley S, Jayaram L (2010) The clinical utility of long-term humidification therapy in chronic airway disease. Respir Med, 104, 525-33
patients on long-term humidification had fewer exacerbations, higher QoL scores and improved lung function than those without.
Turnbull D, Fisher PC, Mills GH et al (2005) Performance of breathing filters under wet conditions. Br J Anaesth, 94, 675-82
bja.oupjournals.org/cgi/content/abstract/94/5/675
effectiveness of HMEs varies, especially under wet conditions
Williams R, Rankin N, Smith T (1996) Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa. Crit Care Med, 24, 11, 1920-9
Wills PJ, Hall RL, Chan W (1997) Sodium chloride increases the ciliary transportability of CF and bronchiectasis sputum. J Clin Invest, 99, 9-13
www.jci.org/cgi/content/abstract/99/1/9
hypertonic saline can double mucus clearance in bronchiectasis and CF
AARC = American Association for Respiratory Care.
ACBT = active cycle of breathing techniques
HME = heat-moisture exchanger
QoL = quality of life