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Equipment for Aerosol-Air-Entrainment

  • Air Entrainment LVN - Uses sterile water and room air.

  • Large Bore Tubes - Two large bore tubes are used for the nebulizer interface to reduce resistance and condensation.

  • Drain Bag - A drain bag is used to collect condensate to prevent re-entry into the system.

Interfaces for Aerosol Therapy

  • Trach Collar - Used to provide humidity to patients with bypassed airways.

  • Face Tent - Provides humidity while minimizing irritation, particularly in trauma cases.

  • Aerosol Mask - Suitable for spontaneously breathing patients.

  • Brigg's Adapter - Designed for endotracheal or tracheostomy tubes, allows weaning from ventilation and supports an open system.

Conditions Necessitating Aerosol Therapy

  • Upper Airway Natural Humidification Compromised

    • Conditions such as post-extubation stridor indicating swelling.

    • Tonsillectomy patients may benefit from soothing cool mist.

Components of Aerosol Setup

  • Aerosol Heater - Utilized to maintain optimal humidity levels.

  • Temperature Probe - Monitors temperature, ideally set to 37°C.

  • O₂ Analyser - Measures fraction of inspired oxygen (FO₂).

  • Total Flow Calculation:

    • Total Flow = 100 LPM

    • O2 flow and entrained room air flow should sum to 100 LPM.

Humidity & Aerosol Therapy

  • Types of Aerosol: Water vapor, bland aerosols, cool, heated aerosols, and medication-infused aerosols.

    • Continuous Aerosol Delivery: Can be done using LVN, sterile water, or bubble humidifiers.

    • Therapeutic Humidity Systems: Includes wick, passover, and active versus passive systems (such as Heat and Moisture Exchangers - HMEs).

Aerosol Medications

  • Delivery Methods:

    • Metered Dose Inhalers (MDI)

    • Dry Powder Inhalers (DPI)

    • Handheld Nebulizers (HHN)

    • Small Volume Nebulizers (SVN)

  • Particle Size: Aerosols are typically within the size range of 2-5 microns for optimal delivery to the airways.

Artificial Airways

  • Endotracheal Tubes: Inserted through the mouth into the trachea to bypass the upper airway.

  • Tracheostomy Tubes: Inserted directly into the trachea; requires external humidification for optimal function.

Active Passover Heated Humidifiers

  • Components:

    • Temperature probes maintaining 37°C.

    • Heating wires to prevent condensation and maintain temperature.

    • Heater plate used to heat water, facilitating the production of water vapor.

    • Reservoir for storing sterile water, designed for continuous use.

Noninvasive Ventilation with SVN

  • Medication Delivery: When combined with noninvasive ventilation, medication delivery can occur under positive pressure conditions.

  • Handheld Nebulizer (HHN): Another method of delivering aerosolized medications.

Valve T-Adapter

  • A device that allows for aerosolized medication delivery without breaking the circuit, typically placed close to the patient for maximum efficiency.

Albuterol Nebulization

  • Indication: Used for asthmatic patients to relieve bronchospasms.

  • Dosage Calculation:

    • Dosage (mg/hr) = Flow rate × mg/mL

    • Example: With 0.5 mL per drop, the dosing via nebulization is calculated accordingly.

Humidity Systems

  • Wick Humidification: Utilizes a blender with small and large bore tubing, temperature probes, and O₂ analyzers to maintain humidity levels.

  • Active Humidity Generation: Requires heat to add water vapor effectively, helps in bypassed upper airways to prevent mucosal drying.

High Flow Nasal Cannula (HFNC)

  • Indications: Applied in cases of pneumonia, asthma exacerbation, bronchospasm, and post-extubation care.

  • Specifications:

    • FO₂ can be 100% and flow rates may reach up to 60 L/min.

    • The system includes a water bag, O2 blender, flow meter, heated circuit, active humidifier heater, and cannula for delivery.

Low Flow Devices Overview

  • Nasal Cannula:

    • Flow Rate: 1-6 LPM

    • FO₂ Concentration: 24-44%

    • Each 1 L/min increase approximates a 4% increase in FO₂ concentration.

  • Simple Mask:

    • Flow Rate: 5-10 LPM

    • FO₂ Concentration: 40-60%

    • Minimum flow of 5 LPM is required to avoid CO2 buildup.

  • Partial Non-Rebreather Mask:

    • Flow Rate: 6-10 LPM

  • Non-Rebreather Mask:

    • Flow Rate: 10-15 LPM

  • Oxymask:

    • Flow Rate: 1-15+ LPM

  • Nasal Cannula with Bubble Humidifier:

    • Flow Rate: 1-6 LPM

    • FO₂ Concentration: 40-70%

    • One-way valve system included.

High Flow Devices

  • Venturi Mask:

    • Flow Rate: 20-60 LPM

    • Provides accurate delivery of predetermined oxygen concentrations (e.g., 24-60%).

  • High-Volume Jet Nebulizer (LVN):

    • Flow Rate: 6-15 LPM

    • FO₂ Concentration: equivalent to 24-30% or as specified (dual).

  • Aerosol Delivery Systems: Includes T-piece, face tent, or driven aerosol mask system, capable of delivering up to 28-100% FO₂ concentration depending on the configuration.