HUMIDIFICATION

-Aishwarya Gatty
MPT (Cardiopulmonary Science)
DEFINITION
• Humidity therapy involves adding water vapour and
(sometimes) heat to the inspired gas.
PHYSIOLOGICAL CONTROL OF
HEAT AND MOISTURE
EXCHANGE
• Heat and moisture exchange is a primary function of the
upper respiratory tract, mainly the nose. The nose heats and
humidifies gas on inspiration and cools and reclaims water
from gas that is exhaled.
• Nose –tortuous path (more contact time); rich vasculature
and endothelium (adds heat or water )

• Isothermic saturation boundary(ISB)

• Factors can shift the ISB deeper into the lungs.
ISB-
• As inspired gas moves into the lungs, it achieves BTPS
conditions (body temperature, 37°C; barometric pressure;
saturated with water vapor [100% relative humidity at 37°C]).

• This point, normally approximately 5 cm below the carina, is

called the isothermic saturation boundary (ISB).

• Above the ISB, temperature and humidity decrease during

inspiration and increase during exhalation. Below the ISB,
temperature and relative humidity remain constant (BTPS).
Factors can shift the ISB deeper into the lungs. The
ISB shifts distally when
• a person breathes through the mouth rather
than the nose when he or she breathes cold, dry
air
• when the upper airway is bypassed (breathing
through an artificial tracheal airway)
• the minute ventilation is higher than normal.
 INDICATIONS FOR
HUMIDIFICATION
• When this shift of ISB occurs, additional surfaces of the airway
are recruited to meet the heat and humidity requirements of
the lung. If these shifts compromise the body's normal heat
and moisture exchange mechanisms, humidity therapy may be
indicated.
• The primary goal of humidification is to maintain normal
physiological conditions in the lower airways.
• Proper levels of heat and humidity help ensure normal
function of the mucociliary transport system.
PRIMARY
• Humidifying dry medical gases
• Overcoming the humidity deficit created when the upper
airway is bypassed

SECONDARY
• Managing hypothermia
• Treating bronchospasm caused by cold air
 CLINICAL SIGNS AND SYMPTOMS OF
INADEQUATE AIRWAY
HUMIDIFICATION
• Atelectasis
• Mucociliary dysfunction
• Destruction of airway epithelium
• Thick, dehydrated secretions
• Dry, non-productive cough
• Increased airway resistance
• Increased incidence of infection
• Increased work of breathing
• Patient complaint of substernal pain and airway dryness
• Atelectasis
 PHYSICAL PRINCIPLES
GOVERNING HUMIDIFIER
FUNCTION
Temperature Time of contact

Surface area Thermal mass

• The greater the temperature of a gas, the more water vapor it
can hold (increased capacity). (40 degree celcius)

• The greater the area of contact between water and gas, the
more opportunity for evaporation to occur. (Bulbble
humidifier-The smaller the bubble, the greater is the ratio of
water to air surface area)
• The longer a gas remains in contact with water, the greater the
opportunity for evaporation to occur (For bubble humidifiers,
contact time depends on the depth of the water column; the
deeper the column, the greater is the time of contact as the
bubbles rise to the surface. In passover and wick-type
humidifiers, the flow rate of gas through the humidifier is
inversely related to contact time, with high flow rates reducing
the time available for evaporation to occur)

• The greater the mass of water or the core element of a

humidifier, the greater is its capacity to hold and transfer heat.
HEATED HUMIDIFIERS
Warmed, humidified gases are used to prevent or treat various
abnormal conditions.
• Treatment of hypothermia-used to raise core temperatures
back to normal.
• To prevent intraoperative hypothermia
• Alleviate bronchospasm in patients who develop airway
narrowing after exercise or when they breathe cold air.
Possible cause :

Primary Hypertonicity
stimulus is of airway lining
probably a fluid
combination Bronchospasm
of airway Release of
cooling and chemical
drying mediators
Types of Humidifiers

HUMIDIFIERS Bubble

Passover

Heat Moisture
Exchangers
(HME)
BUBBLE HUMDIFIER
• A bubble humidifier breaks (diffuses) an underwater gas stream into
small bubbles.

• Use of a foam or mesh diffuser produces smaller bubbles than an

open lumen, allowing greater surface area for gas/water interaction.

• Unheated bubbly humidifiers are commonly used with oronasal

oxygen delivery systems.

• An alternative to dispersing gas bubbles in water is spraying water

particles (aerosol) into the gas. The higher the aerosol density
(number of particles per volume of gas), the greater is the gas to
water surface area available for evaporation.

• The goal is to raise the water vapor content of the gas to ambient
levels
• To warn of flow-path obstruction and prevent bursting of the
humidifier bottle, bubble humidifiers incorporate a simple
pressure-relief valve, or pop-off.
• The pop-off is commonly a gravity or spring-loaded valve that
releases pressures greater than 2 psi.
• Humidifier pop-offs should provide both an audible and a
visible alarm and resume normal position when pressures
return to normal.
• The pop-off can be used to test an O2 delivery system for
leaks by obstructing delivery tubing at or near the patient
interface.
• If the pop-off sounds, the system is leakfree; failure of the
pop-off to sound may indicate a leak (or a faulty pop-off
valve).
DISADVANTAGES
• As gas flow increases, these devices become less efficient as
the reservoir cools and contact time is reduced, limiting their
effectiveness at flow rates higher than 10 L/min.
• Heating the reservoirs of these units can increase humidity
content but is not recommended, because the resulting
condensate tends to obstruct the small-bore delivery tubing to
which they connect.
• At high flow rates, bubble humidifiers can produce aerosols.
Although not visible to the naked eye, these water-droplet
suspensions can transmit pathogenic bacteria from the
humidifier reservoir to the patient.
• Any device that generates an aerosol poses a high risk of
spreading infection
PASSOVER HUMIDIFIER
• Directs gas over a water surface. There are two common types
of passover

PASSOVER
HUMIDIFIER

Wick

Membrane
ADVANTAGES (over bubble humidifier)
• First, in contrast to bubble devices, passover humidifiers can
maintain saturation at high flow rates.

• Second, they add little or no flow resistance to spontaneous

breathing circuits.

• Third, they do not generate any aerosols, and they pose a

minimal risk for spreading infection.
WICK TYPE

• The wick (a cylinder of absorbent material) is placed upright in

a water reservoir and surrounded by a heating element.

• Capillary action continually draws water up from the reservoir

and keeps the wick saturated.

• As dry gas enters the chamber it flows around the wick,

quickly picking up moisture and leaving the chamber fully
saturated with water vapor.

• No bubbling occurs.
MEMBRANE TYPE
• A membrane-type humidifier separates the water from the
gas stream by means of a hydrophobic membrane.
• Water vapor molecules can easily pass through this
membrane, but liquid water cannot.
• Bubbling does not occur
HEAT MOISTURE EXCHANGER
• A heat moisture exchanger (HME) is a passive humidifier that
has been described as an "artificial nose."
• Like the nose, an HME captures exhaled heat and moisture
and uses it to heat and humidify the next inspiration.
• Unlike the nose, however, most HMEs do not actively add heat
or water to the system.
• The typical HME is a passive humidifier, capturing both heat
and moisture from expired gas and returning them to the
patient during the next inspiration.
• An HME must be removed from the patient circuit during in-
line aerosol drug treatments.
 Simple condenser
humidifier

Hygroscopic
HME condenser humidifier

Hydrophobic
condenser humidifiers
SIMPLE CONDENSER HUMIDIFIERS

• Contain a condenser element with high thermal conductivity,

usually consisting of metallic gauze, corrugated metal, or
parallel metal tubes.
• On inspiration, inspired air cools the condenser element.
• On exhalation, expired water vapor condenses directly on its
surface and rewarms it.
• On the next inspiration, cool, dry air is warmed and humidified
as its passes over the condenser element.

DISADVANTAGE
• Able to recapture only approximately 50% of a patient's
exhaled moisture (50% efficiency).
HYDROPHOBIC CONDENSER HUMIDIFIERS
• Use a waterrepellent element with a large surface area and
low thermal conductivity.
• During exhalation, the condenser temperature rises to
approximately 25° C because of conduction and latent heat of
condensation.
• On inspiration, cool gas and evaporation cools the condenser
• down to 10° C.
• This large temperature change results in the conservation of
more water to be used in humidifying the next breath.
• The efficiency of these devices is approximately 70%.
• Some hydrophobic humidifiers also provide bacterial filtration.
HYGROSCOPIC CONDENSER HUMIDIFIERS
• provide higher efficiency by:
- using a condensing element of low thermal conductivity
(e.g., paper, wool, foam)
-impregnating this material with a hygroscopic salt (calcium
or lithium chloride)

• By using an element with low thermal conductivity,

hygroscopic condenser humidifiers can retain more heat than
simple condenser systems can.
• In addition, the hygroscopic salt helps capture extra moisture
from the exhaled gas.

• During exhalation, some water vapor condenses on the cool

condenser element, whereas other water molecules bind
directly to the hygroscopic salt.

• During inspiration, the lower water vapor pressure in the

inspired gas liberates water molecules directly from the
hygroscopic salt, without cooling.

• 7 0% efficiency
TYPES
Bubble humidifiers
ACTIVE
Actively adding Passover humidifiers
heat or water or
both to the device- Nebulizers of bland
patient interface aerosols

Vaporizers
HUMIDIFIERS
PASSIVE
actively adding
heat or water or HME
both to the device-
patient interface
CONTRAINDICATIONS
• There are no contraindications to providing physiological
conditioning of inspired gas during mechanical ventilation.

• However, a (HME) is contraindicated in the following

circumstances:
- For patients with thick, copious, or bloody secretions
- For patients with an expired tidal volume <70% of the
delivered tidal volume (e.g., those with large bronchopleural
fistulas or incompetent or absent endotracheal tube cuffs)
-For patients whose body temperature is <32° C.
- For patients with high spontaneous minute volumes (>10
L/min)
STEAM INHALATION
REFERENCES
• Eagan’s Fundamentals of Respiratory Care
THANKYOU