Humidification and obstruction in the airway of patients with endotracheal intubation
Keywords:
Obstruction of the airway, HumidificatorAbstract
Objective: to determine the frequency of obstruction in the airway of patients with mechanical ventilation, attributed to poor humidification, heating and filtration of the inspired air.
Material and methods: descriptive observational study in patients with mechanical ventilation of the intensive care service.
Data collected: days of mechanical intubation, arterial blood gases, respiratory sounds, characteristics of bronchial secretions, humidity measurements and humidifier temperature.
Results: Sixty-two measurements of humidity and temperature were made, finding that the cascade humidifiers, pneumatic micronebulizer and bacteria and humidity retainer filter showed no significant difference, the Bernoulli humidifier did show difference with p <0.05 compared to the others. Of the patients with a Bernoulli humidifier, 83% presented obstructive problems due to mucous plugs in the airways; with the waterfall system 44%. The average number of intubation days was 10, between the third and fourth days, 58% of the population had mucous plugs.
Conclusions: patients who used a Bernoulli humidifier had more frequent complications due to mucous plug. In relation to the rest of the humidifiers, it could be observed that the lack of water and the extinguished thermostat were the main reasons for obstruction in the airway.
References
Testud L, Jacob 0. Anatomía Topográfica. Octava edición. Barcelona España: Salvat; 1986. p. 311-323.
Dennis W, Glover M, McCarthy G. Terapéutica respiratoria. Octava edición. México: Manual Moderno; 1991. p. 108-113.
Clifford D, Bryan J. Manual de terapéutica respiratoria. Tercera edición México: Manual Moderno; 1990. p. 96-97.
Laurent T, Vialet R, Jean M, Sidier B, Roulier P, Claude M. Efficasy of heat and moisture exchangers after changing every 48 hours rather than 24 hours. Crit-Care-Med 1998; 26 (3): 477-481.
James B, Fink M, Sally A, Krause B, Barrett L, Schaff D. Extendig ventilator change interval beyond two days reduces the likelihood of ventilatorassociated. Clinical investigations in critical care. Chest 1998; 113(2): 405-411.
Berkow R, Andrew I, Fletcher M. Manual de merck diagnóstico y terapéutica. 9a.edición. Madrid España: Mosby/ Doyms; 1994. p. 1816-1849.
Case Report Sprung L J, Lozada G, Zanettin, Banoub M. Bipolar Atelectasis after difficult tracheal intubation. The Cardiopulm Critic Car. 1997; 52(12): 1207-1211.
Cunningham ET, Ravich WJ, Jones B, Doonner MW. Vagal reflexes referred from the upper acrodigestive tract: And infrequently recognized cauce of common cardiorespiratory responses. Ann Intern Med 1992; 116: 575-82.
Takats G, Fenn GK, Jenkinson EL. Retlex pulmonary atelectasis. JAMA 1942; 120: 686-90.
Cook D, Bernard J, Brochawd L, Brunbuison C. The Journal of the American Medical Association. Influence of airway management on ventilatorassociated pneumonia. JAMA 1998; 279 (10): 781-787
Brian P. 0, Joseph J.F, Shawm M. A cauce of prolonged atelectasis in intubacion children. Chest. 1998; 113(2): 537-540
Logston B, Wooldridge R, King M. Terapia intensiva. Procedimientos de la American Association of critical care nurse. Tercera edición. Buenos Aires Argentina: Panamericana; 1995: p.12-18.
