Humidification
A tracheostomy bypasses the normal upper airway mechanisms for humidification, filtration and warming of inspired gases. This results in increased viscosity of mucus secretions, which depresses cilary function and therefore mucocilary transport. This in turn can lead to an increased risk of infection, impaired secretion removal and microatelectasis. Failure to provide adequate humidification to address these issues can lead to obstruction of the major airways and tracheostomy tube blockage.
There are various methods to provide supplementary humidification according to the patients individual needs, however it is most important to ensure the patient has adequate systemic hydration. This may be via enteral feeding or parenteral fluids; however if the patient has been assessed as having a competent swallow they may be able to maintain some or all of their own hydration through drinking.
Methods of humidifation for ventilated patients
For all patients with loose or no evidence of secretions, place a Heat and Moisture Exchanger (HME) in the inspiratory circuit
Replace HME every 24 hours or more frequently if contaminated by secretions
To moisten inspired gases by trapping and re-breathing humidity
To maintain effectiveness and reduce infection risk
For patients with thick secretions, ensure 4-6 hourly prescription of saline nebulisers
Review need daily
To loosen secretions, to prevent atelectasis and sputum thickening
To reduce unnecessary interventions and to assess whether present level of humidification adequate
For patients with difficult to clear secretions or evidence of consolidation, replace HME with a humidifier such as the Fischer Paykel™ water humidifier
Review need daily
In patients with very difficult to clear secretions, a mucolytic may be considered
Warmed water carries a greater relative humidity
To reduce unnecessary interventions and to assess whether present level of humidification adequate
Self ventilating patient requiring oxygen therapy
All patients require cold water venturi humidification using an aquapak™ system
Check water supply 2 hourly and change system every 24 hours
To moisten inspired gases
To ensure adequate humidification and reduce infection risk
For patients with thick secretions, ensure 4-6 hourly prescription of saline nebulisers
Review need daily
To loosen and thin secretions, to prevent atelectasis and sputum consolidation
To reduce unnecessary interventions and to assess whether present level of humidification adequate
For patients with difficult to clear secretions or evidence of consolidation, replace cold water venturi humidifier with warm water humidifier such as the Fischer Paykel™
Review need daily
In a patient with very difficult to clear secretions, a mucolytic may be considered
Warmed water carries a greater relative humidity
To reduce unnecessary interventions and to assess whether present level of humidification adequate
Self ventilating patient not requiring oxygen therapy
For all patients with loose or no evidence of secretions use an HME. The buchanon™ protector should be used for longer term patients and is preferable in patients with copious secretions where there is a risk of tube occlusion
In the acute ward replace HME every 24 hours or more frequently if contaminated by secretions (check four hourly)
To moisten inspired gases by trapping and rebreathing humidity, to prevent inhalation of particulate matter
To maintain effectiveness and reduce infection risk
For patients with thick / dry secretions, ensure 4-6 hourly prescription of saline nebulisers
Review systemic hydration – inform medical staff
Review need daily
In a patient with very difficult to clear secretions a mucolytic may be considered
To loosen and thin secretions, to prevent atelectasis and sputum consolidation
To highlight problem and introduce and early intervention where required
To reduce unnecessary interventions and to assess whether present level of humidification adequate
