HUMIDITY AND AEROSOL THERAPY

• Active humidification system


  Adjustments and monitoring of inspired gas temperature is important
• Excessive temperature


  May result in hyperpyrexia, overhydration and tachycardia
• Inadequate gas temperature


  Can cause hypothermia, increased O2 consumption and hypoxemia (low PaO2)
• Low flow O2 devices


  Nasal cannula, O2 mask, non-rebreathing or partial rebreathing masks making use of bubble humidifiers are generally acceptable (non-heated)
• Ideal design features of pediatric humidifiers

  • Minimal internal volume and constant water level to minimize compressed volume loss
  • Closed, continuous feed water supply to avoid contamination
  • Detachable hot plate heating system
  • Distal airway temperature sensor and high/low alarms
• Aerosol therapy


  Good alternative to systemic routes, especially for pulmonary disorders. Safer and more comfortable than oral and parenteral approaches to pediatrics
• Small volume nebulizer (SVN), metered dose inhaler (MDI) and dry powder inhaler (DPI)


  Can be used if the child can already follow instructions
• If patient is on mechanical ventilator

  1. Place SVN on the inspiratory limb at not more than 18 inches away from the patient wye

  2. Dilute drug with NSS (4 ml is ideal) and set flows to 6-8 LPM for O2 or air driven in-line nebulization

  3. Adjust ventilator flow to maintain pretreatment settings (do not forget to return settings after treatment!!)
• Tap sides of the SVN

  To minimize dead volume
• MDI adaptor


  Used if physician prefers to deliver aerosolized medication through MDI, instead of SVN

  
• If patient is intubated, supplemental heated humidification becomes necessary