Why humidify oxygen

Use caution when adjusting the flow meter. Oxygen delivery method selected depends on:. Note : Oxygen therapy should not be delayed in the treatment of life threatening hypoxia. Note: In most low flow systems the flow is usually titrated on the oxygen flow meter and recorded in litres per minute LPM.

Where the Airvo2 is used as an oxygen delivery device the flow from this device is independent to the flow of oxygen. Oxygen therapy can be delivered using a low flow or high flow system. All high flow systems require humidification. The type of humidification device selected will depend on the oxygen delivery system in use, and the patient's requirements.

The humidifier should always be placed at a level below the patient's head. Please consult user manuals for any other models in use. Has two modes:. When commencing therapy on a new patient, ensure the disinfection cycle was performed. An orange traffic light confirms the AIRVO 2 has not been cleaned and disinfected since last use, and is not safe for use on a new patient.

Follow the instructions in the disinfection kit manual :. Click to view the delivery mode quick reference table. This system is simple and convenient to use. Simple nasal prongs are available in different sizes. To ensure the patient is able to entrain room air around the nasal prongs and a complete seal is not created the prong size should be approximately half the diameter of the nares. Select the appropriate size nasal prong for the patient's age and size. For nasal prong oxygen without humidification a maximum flow of:.

With the above flow rates humidification is not usually required. However, if humidification is clinically indicated - set up as per the recommended guidelines for the specific equipment used. As with the other delivery systems the inspired FiO2 depends on the flow rate of oxygen and varies according to the patient's minute ventilation. If the required flow rate exceeds those as recommended above this may result in nasal discomfort and irritation of the mucous membranes. Therefore, humidification of nasal prong oxygen therapy is recommended.

For nasal prong oxygen with humidification a maximum flow of:. Optiflow nasal prongs are compatible for use in humidified low or high flow oxygen delivery. See guide below for recommended patient sizing and flow rates. Fisher and Paykel Optiflow nasal cannula junior range Four sizes of prongs:. See Appendix A for further information regarding appropriate junior range sizing: Fisher and Paykel Optiflow junior range sizing guide. RT circuit - click here for instructions for use.

This valve has been designed to minimize the risk of excessive pressure being delivered to the infant in the event that the nasal prongs seal around the infant's nares while the mouth is closed.

The image below is of the RT circuit. RT Circuit and O2 stem - click here for instructions for use. High Flow in approved areas only. Optiflow Nasal Prong junior and standard humidification and flow rate guide for Airvo.

At RCH both simple face masks in various sizes and tracheostomy masks are available. The minimum flow rate through any face mask or tracheostomy mask is 4 LPM as this prevents the possibility of CO 2 accumulation and CO 2 re-breathing.

Select a mask which best fits from the child's bridge of nose to the cleft of jaw, and adjust the nose clip and head strap to secure in place. Oxygen via intact upper airway via a simple face mask at flow rates of 4LPM does not routinely require humidification. Additionally in some conditions eg. Asthma , the inhalation of dry gases can compound bronchoconstriction.

A non-rebreathing face mask has an oxygen reservoir bag and one-way valve system which prevents exhaled gases mixing with fresh gas flow. The non-rebreathing mask system may also have a valve on the side ports of the mask which prevents entrainment of room air into the mask.

While a specific FiO 2 is delivered to the patient the FiO 2 that is actually inspired by the patient ie what the patient actually receives varies depending on:. At the RCH, oxygen therapy via an isolette is usually only for use in the Butterfly neonatal intensive care unit. See Isolette use in paediatric wards , RCH internal link only. Appendix A - Pediatric sizing guides for nasal prongs. Fisher and Paykel Optiflow junior range sizing guide.

The evidence table for this guideline can be viewed here. Please remember to read the disclaimer. Updated July The Royal Children's Hospital Melbourne. Oxygen delivery. Oxygen delivery Aim Introduction Definition of terms Normal values and SpO 2 targets Indications for oxygen delivery Nurse initiated oxygen Patient assessment and documentation Weaning oxygen Selecting the delivery method Low flow delivery method High flow delivery method Considerations Links Appendix A - Paediatric sizing guides for nasal prongs Evidence Table References Aim The aim of this guideline is to describe the indications and procedure for the use of oxygen therapy, and its modes of delivery.

Give oxygen therapy in a way which prevents excessive CO 2 accumulation - i. Reduce the work of breathing. Ensure adequate clearance of secretions and limit the adverse events of hypothermia and insensible water loss by use of optimal humidification dependent on mode of oxygen delivery. Maintain efficient and economical use of oxygen. Figure 2 shows the results of the PP non-inferiority analysis for the item discomfort score recorded at H6—H8.

For sensitivity reasons, a mITT analysis was also performed [ 13 ]. It provided the same results as the PP analysis not shown. Item-by-item results of the item comfort score are provided in figure AF-4 of AF. Absolute difference with confidence interval between the item comfort scores at H6—H8 after randomization between humidified oxygen HO and non-humidified NHO oxygen. The mITT analysis gave the same results not shown. Absolute difference with confidence interval between the item comfort scores at H24 after randomization between humidified oxygen HO and non-humidified NHO oxygen.

Relative differences are also displayed in Fig. Relative difference with confidence interval between non-humidified oxygen NHO group mean score and humidified oxygen HO group mean score at H6—H8 and H Bubble oxygen humidification had no effects on the need for intubation or noninvasive ventilation during ICU stay. This randomized non-inferiority study demonstrated that oxygen therapy-related discomfort was relatively low among oxygen-dependent ICU patients. Conversely to the set hypothesis, this study did not allow to conclude that delivering dry oxygen was non-inferior than delivering oxygen moistened with bubble humidifiers after 6—8 h of oxygen administration.

These score levels are much lower than previous data reported by Campbell et al. The discomfort recorded in the present study was also lower compared to the data of Chanques et al. Possible explanations of these differences could be the use of non-comparable scales to assess comfort or different thresholds chosen to conclude to significant discomfort. However, the mean comfort score values collected in our study were much lower than expected with very tight difference between the HO and NHO groups.

In addition, the dispersion of the values was much broader than expected. Consequently, the power of our study turns out to be insufficient to conclude to non-inferiority of delivering dry oxygen. Considering the item score values recorded in our study and a clinically significant threshold of 5.

This number seems definitely too high to repeat the study to be able to answer to the question of potential non-inferiority of using bubble humidifiers to deliver oxygen to ICU patients. We also evaluated comfort on a prolonged period of time.

In addition to the limited power of this study, some other limitations have to be mentioned. First, the discomfort scale used in the present study is new and not standardized. It was not validated in previous works.

A scale validation was, however, performed in the same dataset but in other patient groups and is provided in AF. Second, no formal delirium diagnosis was performed before the oxygen-related discomfort assessment. To standardize the oxygen-related discomfort assessment, a health practitioner asked the patient to quote each of the fifteen items of the scale one by one.

Third, as both comfortable and uncomfortable patients were included in the study, it could have been difficult to demonstrate a benefice potentially limited to the uncomfortable patients. Fourth, the subgroup analyses comprised a relatively small number of patients. Fifth, this study did not address the question of the impact of bubble humidification in tracheostomized or in pediatric patients.

Finally, the conclusions of our study cannot be generalized for heated humidification, a technique with much higher potential to moisten delivered gas.

Further studies are needed to explore the specific question of heated humidification on comfort at different gas flows. This study failed to demonstrate the non-inferiority, in terms of comfort, of dry oxygen compared to bubble-humidified oxygen in critically ill patients receiving oxygen after 6—8 h of oxygen therapy. No differences in clinical outcomes were found between dry oxygen and bubble-humidified oxygen. Stressors in ICU: perception of the patient, relatives and health care team.

Intensive Care Med. Subjective effects of humidification of oxygen for delivery by nasal cannula. A prospective study. Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients. Humidity in anaesthesiology. Heat and moisture patterns in the respiratory tract during anaesthesia with the semi-closed system. Can Anaesth Soc J. Article Google Scholar.

Randomized double-blind trial of the effects of humidified compared with nonhumidified low flow oxygen therapy on the symptoms of patients. Can Respir J. Humidification of oxygen during inhalational therapy. N Engl J Med. Estey W. Subjective effects of dry versus humidified low flow oxygen. Respir Care. Google Scholar. Is humidified better than non-humidified low-flow oxygen therapy?

A systematic review and meta-analysis. J Adv Nurs. Fulmer Snider. Arch Intern Med. PubMed Google Scholar. British thoracic society emergency oxygen guideline group, BTS emergency oxygen guideline development group. BTS guideline for oxygen use in adults in healthcare and emergency settings. Dominic Dellweg. Introduction Oxygen administration via nasal cannula was established several decades ago. What this paper contributes to our knowledge Pre-nasal administration of dry oxygen had intranasal humidity similar to intranasal administration with bubble humidifier.

Methods Ethics The protocol and equipment were approved by the ethics committees of the medical council and of the University of Muenster, Westfalen, Germany f-S. Calibration of the Measurement System To validate our measurement device we performed comparative measurements with a standard industrial hygrometer Testo , Testo, Lenzkirch, Germany.

Statistics Data are expressed as mean and standard deviation. Results The results of the system calibration measurements showed excellent correlation between the standard hygrometer and our newly developed device, with a Pearson correlation coefficient of 0.

Discussion In this study we have shown, using a newly developed system for measuring relative humidity, that relative humidity in the nasal cavity drops significantly, even at low flow of intra-nasally administered dry oxygen. Conclusions We introduced a helpful and valid tool to measure relative humidity in air-filled body cavities such as the nasal cavity. E-mail: d. The authors have disclosed no conflicts of interest. References 1.

Oxygen administration by nasal catheter. BMJ ; 1 : - Nocturnal Oxygen Therapy Trial Group. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Ann Intern Med ; 93 3 : - Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema.

Lancet ; 1 : - Pneumologie ; 55 10 : - Article in German. OpenUrl PubMed. BTS guideline for emergency oxygen use in adult patients. Thorax ; 63 Suppl 6 : vi1 - Erratum in: Thorax ;64 1 American Thoracic Society.

Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. A new oxygen applicator for simultaneous mouth and nose breathing. Chest ; 4 : - Nasal septal perforation and oxygen cannulae. Hosp Med ; 62 4 : Treatment of home oxygen induced rhinitis: an unusual use for a nasal obturator.

Rhinology ; 42 4 : - Miyamoto K , Nishimura M. Nasal dryness discomfort in individuals receiving dry oxygen via nasal cannula. Respir Care ; 53 4 : - Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients. Intensive Care Med ; 35 6 : - Bacterial colonisation of humidifier attachments on oxygen concentrators prescribed for long term oxygen therapy: a district review.

Thorax ; 46 4 : - A comparison of the rate of bacterial contamination for prefilled disposable and reusable oxygen humidifiers. J Crit Care ; 20 2 : - Bou R , Ramos P. Outbreak of nosocomial Legionnaires' disease caused by a contaminated oxygen humidifier.

J Hosp Infect ; 71 4 : - Community-acquired Pseudomonas aeruginosa pneumonia associated with the use of a home humidifier. West J Med ; 4 : - The performance of nasal catheters and a face mask in oxygen therapy. Lawrence MG. The relationship between relative humidity and the dew point temperature in moist air: a simple conversion and applications. Bull Am Meteorol Soc ; 86 : - Paul J , Otvos T. Comparison of nasal cannulas and the OxyArm in patients requiring chronic domiciliary oxygen therapy.

Can Respir J ; 13 8 : - Humidification of inspired gases during mechanical ventilation. Minerva Anestesiol ; 78 4 : - Dery R. Humidity in anaesthesiology. Determination of the alveolar humidity and temperature in the dog.

Can Anaest Soc J ; 18 2 : - Subjective effects of humidification of oxygen for delivery by nasal cannula. A prospective study. Chest ; 93 2 : - Randomized double-blind trial of the effects of humidified compared with nonhumidified low flow oxygen therapy on the symptoms of patients.