• Invasive Ventilation

    Invasive ventilation is a mode of respiratory support that replaces spontaneous breathing in neonates and infants, with an artificial airway such as an endotracheal tube.
    Delivering heated and humidified gas is widely recommended and practiced during invasive respiratory support of neonates and infants.

In a healthy airway, gas is heated and humidified by the upper airway during inspiration, and is fully saturated with water vapor at core body temperature (typically 37 °C, 44 mg/L) when it reaches the distal airways.1 

However, during invasive ventilation the upper airway is bypassed, along with its natural airway protection and humidification mechanisms; therefore, heating and humidifying gases while this treatment is being delivered is important.1,2

Why is humidification important? 

Medical gas is typically cold and dry (≤ 15°C, < 2% Relative Humidity) compared to ambient air (22 °C, 50% Relative Humidity). The delivery of cold, dry gas to the airway is associated with increased water and heat loss, inflammation in the airway epithelium, and an increased risk of airway injury. Insufficient humidification may also impair secretion clearance and increase the risk of airway blockages. These effects are amplified in preterm infants, where a few minutes of ventilation with insufficient humidification has been shown to increase airway resistance, reduce lung compliance, increase the risk of air leaks, and the need for supplemental oxygen delivery.1,2

There are several key benefits associated with humidification.3–6 

Reference:

1. Avery’s Diseases of the Newborn. (W.B. Saunders, 2012).

2. Schiffman, H. Humidification of respired gases in neonates and infants. Respir. Care Clin. N. Am. 12, 321–336 (2006).

3. Tarnow-Mordi, W., Reid, E., Griffiths, P., & Wilkinson, A. Low inspired gas temperature and respiratory complications in very low birthweight infants. J. Pediatr. 114, 438–442 (1989).

4. Greenspan, J., Wolfson, M., & Shaffer, T. Airway responsiveness to low inspired gas temperature in preterm neonates. J. Pediatr. 118, 443–445 (1991).

5. Williams, R., Rankin, N., Smith, T., Galler, D., & Seakins, P. Relationship between the humidity and temperature of inspired gas and the function of airway mucosa. Crit. Care Med. 24, 1920–1929 (1996).

6. Branson, R. & Gentile, M. Is humidification always necessary during noninvasive ventilation in the hospital? Respir. Care 55, 209–216 (2010).

Assists natural defense mechanisms in the airway

Promotes conservation of energy for growth and development

Supports patient comfort and therapy tolerance

Delivering heated and humidified gas during respiratory support assists with secretion mobilization and removal.

Infants need energy for growth and development therefore, assisting in thermoregulation can help conserve energy for these tasks.

Humidification is associated with clearance of retained secretions and prevention of airway drying. Adequate humidification during respiratory support may improve patient comfort and therapy tolerance.

Assists natural defense mechanisms in the airway

Delivering heated and humidified gas during respiratory support assists with secretion mobilization and removal.

Promotes conservation of energy for growth and development

Infants need energy for growth and development therefore, assisting in thermoregulation can help conserve energy for these tasks.

Supports patient comfort and therapy tolerance

Humidification is associated with clearance of retained secretions and prevention of airway drying. Adequate humidification during respiratory support may improve patient comfort and therapy tolerance.

  • Invasive ventilation circuits

    The Fisher & Paykel Healthcare Evaqua™ 2 breathing circuits
    help minimize mobile condensate in the expiratory limb by allowing
    water vapor to diffuse through the tubing wall.

Evaqua™ 2 technology

The circuits incorporate Evaqua 2 technology, which allows excess humidity to diffuse through the circuit wall before it condenses, eliminating the need for water traps. The Evaqua 2 expiratory tube of the breathing circuit is made from a material containing millions of permeable cells.

Water vapor is able to diffuse through the permeable membrane to the outside of the tube. As there is less condensate collecting in the tube, circuit breaks can be minimized and the breathing circuit can remain a closed system. The Evaqua 2 tube wall is made up of many layers, making it robust and resistant to kinking and damage.
With conventional water trap circuits, condensate can form in the expiratory limb where humidity in the gas-flow touches cooler surfaces along the gas path. Evaqua 2 technology allows water vapor to diffuse through the expiratory limb wall before it has an opportunity to condense into liquid water within the circuit limb or the ventilator.
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