为什么要用湿化器无创辅助通气：湿化效果如何保证
目 录
01-无创通气概念
02-湿化相关概念及原理
03-主动湿化和被动湿化特点
04-无创通气湿化效果的影响因素
05-无创通气：如何保证湿化效果
06-小结
Yb Song, Jiangsu Province Hospital
在ICU里无创正压通气常用通气模式：持续气道正压（CPAP）、双水平气道正压（BiPAP)。
气道湿化不足的临床症状和体征
·Atelectasis肺不张
·Dry, nonproductive cough干咳，无痰的咳嗽
·Increased airway resistance气道阻力增高
·Increased incidence of infection 感染率增加
·Increased work of breathing 呼吸做功增加
·Patient complaint of substernal pain and airway dryness患者主诉胸骨后疼痛和气道干燥
·Thick，dehydrated secretions分泌物黏稠干燥
无创通气未使用湿化
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HMEE
人工鼻（HME）的局限性
1Branson & Hess, 1995; 2Branson & Davis, 1996;3Girault et al., 2003; 4Prat et al., 2003
一些文献比较了很多人工鼻，发现它都没有达到相关标准推荐的湿度，所以在选择时还要注意它的性能。
无创辅助通气的湿化
Factors Contributing to Insufficient Gas Conditioning During NIV
·Factors affecting the airway conditioning during NIV procedures include：the type of ventilator、inspiratory positive airway pressure (IPAP)、inspiratory fow、fractional inspired oxygen (FiO2)、air leaks、interface、temperature of the inhaled gas and type of humidifer.
factors related with hygrometry levels during NIV
1. Level of air leaks
2.Design of the interface ( dead space)
3. Respiratory pattern
4.Design of the ventilator (for example, high inspiratory flow CPAP system)
5.Setting of the IPAP/EPAP levels
6.Inspiratory oxygen fraction（FiO2)
7. Place of the sensor
A. M. Esquinas (ed.),Humidification in the Intensive Care Unit, 2012
无创通气应用时还需关注
影响冷凝水的因素
·整个系统（加湿器到气道的温差）
·环境温度
·气体流量
·设定的气道温度
·呼吸回路的长度、直径和热质量
使用加热湿化器需关注的问题
2.Active humidification is suggested for noninvasive mechanical ventilation , as it may improve adherence and comfort.
Respir Care 2012;57(5): 782-788.
选择合适的鼻面罩
湿化监测
-Observe that the tubing drains the water downwards and not toward the artificial airway or the ventilator.
-Place the water traps correctly to receive drained water.
-Frequently monitor the active humidifier device (water level, temperature level, check the presence of condensation).
-Never fill above the recommended level.
-Do not drain the condensation toward the humidifier chamber.
-Comply with the manufacturer's specifications.
湿化方式推荐
Rev Bras Ter Intensiva. 2018;30(1): 86-97
湿化方式应用趋势
·Non-heated wire humidifers are becoming increasingly less popular because of the concerns over respiratory condensation.
·In patients requiring long-term mechanical ventilation >96 h，the HWHs are the device of choice.Other indications for heated humidifers (HHs) include contraindications for HMEs.
·Heated humidifcation devices are capable of delivering gases with 100% relative humidity near 37 ℃ body temperature.
·Inappropriate settings of temperature or humidifcation can also lead to increased resistive work of breathing due to mucous plugging and/or life-threatening occlusions of endotracheal or tracheostomy tubes .
Humidifcation in the Intensive Care Unit
·气道湿化是无创辅助通气患者的关键干预措施。
·湿化设置或设备选择或使用不当可能会损害气道黏膜、延长机械通气或增加工作量，甚至产生气道堵塞不良后果。
·护理人员了解每种湿化装置的优点和缺点，正确使用、严密监测及时评价湿化效果对于患者成功实施无创通气是至关重要的。
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