AEROSOL AND HUMIDITY

THERAPY
FINAL TERM
What is mucociliary clearance?
• Refered to as mucociliary apparatus or escalator derived from mucus,
cilia and clearance describes the self clearing mechanism of the
bronchi.

• Normal versus Impaired Mucociliary Clearance:

• Under normal conditions, the mucociliary escalator is capable of removing
particular debris from the lung. The cilia beat rhythmically through watery sol
layer with the ends of the cilia lightly pushing the gel layer toward the
pharynx, where secretion are coughed out or swallowed.
• Impaired mucociliary clearance has alteraions in mucus production or
ciliary
activity will result in retention of secretion.
Humidity Therapy
• Humidity is the degree of moisture in the air.
• Is the therapeutic use of water to prevent or correct moisture
deficit in the respiratory tract.
• Under normal conditions the respiratory tract is kept moist by
humidifying mechanism that allow evaporation of water from the
respiratory mucusa.
• If these mechanism fail to work, they are bypassed or, are inadequate
to overcome drying and irritating effects of therapeutic gases and
mucosal crusting, some sort of humidifying must be provided.
The Principal Reasons for Employing
Humidity Therapy are:
• To prevent drying or irritation of the respiratory mucosa.
• To facilitate ventilation and diffusion of O2 and other therapeutic gases
being used.
• To aid in removal of thick and viscous secretions that obstruct the
airways.
• To aid in obtaining an induced sputum specimen.
• To promote a cough to clear secretions.
• To promote adequate humidity in the presence of artificial airway.
• To deliver adequate humidity when using dry gases for therapeutic
purposes.
Humidity Therapy can be delivered in a
variety of ways:
• Humidifiers and vaporizers increase the water content of an
environment and are limited to the treatment of upper respiratory
disorders because they can produce particles that are too large to
penetrate deeply into the lungs.
• Nebulizers generates clouds or mist particles that are extremely small
and thus capable of penetrating more deeply into the bronchioles
and small structures of the lower respiratory tract.
Principle of Humidification
• Humidity – the presence of moisture in gas in its molecular form.
⮚ Importance to the pulmonary system:
✔ Maintains fluidity of mucociliary escalator.
✔ Maintains moisture and compliance of the lung parenchyma.
⮚ Amount of humidity lost per day is 500 ml
✔ 250 ml is recaptured by the nasal pharyngeal mucosa.
⮚ Inhalation of dry gases could result in the ff:
✔ Impaired ciliary ability
✔ Slowed mucus movement
✔ Inflammation and necrosis of the pulmonary epithelium.
✔ Retention of thick secretions and incrustations.
✔ Bacterial infiltration of mucosa, atelectasis and pneumonia.
• Absolute Humidity – actual content of H2O vapor in gas measured in
milligrams
• Potential Humidity – the maximum amount of water vapor that a gas
can hold at a given temperature.
• Relative Humidity – the amount of water vapor in gas as compared to
the maximum amount possible, expressed as percentage.
Clinical Applications
• Always humidify a dry gas to prevent adverse reactions.
• Additional reasons for humidity therapy:
⮚ Impaired ability to cough and move secretions.
✔ Can be due to age, neuromuscular status, surgery, trauma, or disease process.
⮚ Presence of very thick, abundant amounts of secretions.
⮚ Delivering medications
• Evaluation of the effectiveness of the therapy.
⮚ Look at the patients secretions
✔ Is the treatment having the desired effects
✔ Is there something more that you should do.
⮚ Listen to breath sounds:
✔ Note general condition, cough, amount, type and duration of cough.
⮚ Look for clearing or improvement in chest x-ray.
Humidifiers
• Purpose is to deliver gas with maximum of water vapor content.
• Must be heated or unheated
• Most can deliver 80%-100% of relative humidity.
• Factors effecting the efficiency of the device.
✔Temperature - as temperature increase, more water molecules escape into the gas
adding humidity.
✔Time of exposure between gas and water – the longer the exposure the better the
chance for evaporation.
✔Surface area involved in gas/water contact – the more surface area. The more water
exposed to evaporation.
✔Gas flow – high flow decreases exposure of gas to water.
Type of Humidifiers
• Passover or Blow-By Humidifier
⮚ A humidifying device that directs a dry gas source over a
water surface area and then flows to the patient.

• Bubble Humidifier
⮚ This system uses a conduction system which allows
the gas to be introduced into the water below
the surface.
• Jet Humidifiers
⮚ This unit actually forms an aerosol, however, if
employs “baffles” to break the particles into small
droplets, allowing them to evaporate.

• Wick Humidifiers
⮚ The most common humidifier, an “evaporative”, “cool mist”
or “wick humidifier” consist of just a few basic parts: a
reservoir, wick and fan.
• Heated Wire Circuit
⮚ Heated wire circuit complements the
humidification therapy and is designed with
patient safety and reliability in mind.
⮚ The heated wires heat the air in the circuits
and maintain temperature along the tube
to
ensure continuous delivery of warm and
humid air of optimum level to
patient.
• Heat Moisture Exchange (HME)
⮚ Also called hydroscopic condenser or artificial nose.
⮚ A humidification device that can contains absorptive
material that absorbs heat and moisture from
patient’s exhaled air and dissipates that absorbed
heat and moisture into the patient’s inspired air.
• Membrane Cartridge Systems:
⮚ A humidification system that can heat and humidify O2 at flow
rates up to 40 L/min.
⮚ Oxygen can be delivered to the patient by nasal cannula.
⮚ The device is safe, easy to use and can provide almost 100% of
humidity.
• Heated Humidifier
⮚ The heated humidifier are used when it is necessary to deliver gas directly to
the tracheobronchial tree.
⮚ Can deliver 100% of relative humidity at what ever
temperature used.
AEROSOL THERAPY

• Aerosol is not the same as humidity. Humidity is water in gas in

molecular form.
• Aerosol are liquid or solid particles suspended in gas between 0.005
and 50 in size.
• Aerosol Therapy is the use of an aerosol for respiratory care in the
treatment of bronchopulmonary disease.
Goals of Aerosol Therapy
• To improve bronchial hygiene
✔Hydrate dried retained secretion
✔Improve efficiency of cough mechanism
✔Restore and maintain normal function of mucociliary escalator.
• To humidify gases delivered to patient with artificial airways.
• To deliver drugs to the pulmonary tree.
• To induce sputum for laboratory studies.
Indications of Aerosol Therapy
• Prevention of humidity deficit resulting from the inspiration of dry
gases.
• Dehydration of nasal and pulmonary mucosa resulting from the
inspiration of dry gas as seen in post surgical patient.
• Presence of humidity deficit resulting from inspired air bypassing the
upper airway during the use of artificial airway.
• Presence of thick, retained secretion due to condition such as chronic
bronchitis or cystic fibrosis.
Potential Hazards of Aerosol Therapy
• Increased airway obstruction from the swelling of dried, retained
secretion.
✔Usually a problem with ultrasonic nebulizers more than with pneumatic
nebulizers.
✔Seen primarily in debilitated patients with poor cough mechanism.
• Precipitation of bronchoconstriction and bronchospasm.
✔Most common in asthmatic patients
✔May follow administration of certain drugs.
• Systemic Fluid Overload
✔Primary a problem with neonates and infants.
✔Associated with use of ultrasonic nebulizers more than pneumatic
nebulizers.
• Cross-contamination
Factors Affecting Area of Deposition of
Particles
• Stability – Tendency of particles to remain in suspension.
• Penetration and Deposition
✔Penetration refers to the depth within the respiratory tract that an aerosol
reaches.
✔Deposition is the rain out of aerosol particles within the respiratory tract.
• Composition of Aerosol Particles.
✔Hypertonic particles absorbs water becomes larger and rain out.
✔Hypotonic particles evaporates and get smaller, go deeper into tree.
✔Isotonic particles (0.9% NaCl) stay stable in size until deposited.
• Heating and Humidification
✔Particle size increases as warm gases cools
✔Due to condensation of humidity upon aerosol.
• Ventilatory Pattern
✔This is the most important variable that be controlled to insure maximum
penetration and deposition of aerol particles.
✔Patient should be instructed:
✔ Take a slow deep breath
✔ Inhale through an open mouth (not through the nose)
✔ At the end of inspiration, use an inspiratory pause, if possible, to provide masximum
deposition.
✔ Follow with a slow, complete exhalation through the nose.
Nebulizer
• The nebulizer are devices which produces an aerosol.
• Nebulizers are classfied as pneumatic or electric nebulizers.
• Comparison of Pneumatic and Ultrasonic Nebulizers.
✔Total Volume of aerosol output
✔Pneumatic Nebulizer: 1-15 cc/mim
✔Ultrasonic Nebulizer: 6 cc/min
✔Particle size
✔Pneumatic Nebulizers: 55% of particles produce fall in therapeutic range of 1-5 uc
✔Ultrasonic Nebulizer: 97% particles produced fall in therapeutic range of 1-5uc
Types of Nebulizers

1. Pneumatic Nebulizers or Aerosol Generators

✔ The most common nebulizer use the Venturi effect to produce aerosol and
entrain a second gas.
✔A system of baffles is utilized to impart out the large particles.
✔The nebulizers are commonly used in delivery of medications and for
humidification of inspired gases
• Jet Nebulizer
✔The most common method of producing aerosol
for use in respiratory therapy
✔Utilizes a high velocity gas flow to generate aerosol
particles from a water reservoir of Bernoulli’s effect
• Large Volume Nebulizer
✔Are utilized to deliver bland aerosol to the upper airway
to decrease chances of edema or humidity deficit.
✔ Output: 1-2 mL/minute
• Small Volume Nebulizer or Hand Held Nebulizer
✔Are use to nebulize small dozes of medication
✔Powered by a pressurized power source.

• Small Particle Aerosol Generator

✔The nebulizer specifically design to deliver Ribavirin
(Virazole) for treating Respiratory Syncytial Virus
Infection.
✔ Not to be used with other substance.
2. Ultrasonic Nebulizers
• The ultrasonic nebulizers function by
transforming standard household current
into ultrasonic sound waves.
• The USN works on the principle that
high frequency sound waves can break
up water into aerosol particles.

• Advantages includes: High aerosol output,

Smaller stabilize particle size, Deeper penetration
into the Tracheobronchial Tree (Alveolar level)
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