Is humidification necessary?
Is humidification necessary?
Is humidification necessary?
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>Is</strong> moist<br />
<strong>necessary</strong><br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
NICU Karolinska University<br />
Hospital Stockholm<br />
Här ska vi ha en bild på niva<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
NICU Karolinska University<br />
Hospital Stockholm<br />
‣ 9 beds including 1 isolation room<br />
‣ Mainly patients with neurosurgical, neurological<br />
and infection diagnosis admitted<br />
‣ 469 admittances 2010<br />
‣ 82 nursing staff working on 24 hour rotation<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
Aim<br />
‣ Investigate and evaluate the effects of heated<br />
<strong>humidification</strong> on patients admitted to<br />
Neurointensive Care unit in need of invasive<br />
mechanical ventilation.<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
Hypothesis<br />
‣ Humidified heated ventilation:<br />
- reduces duration of invasive mechanical ventilation.<br />
- reduces NICU length of stay.<br />
- reduces ventilator associated pneumonia (VAP).<br />
- reduces airway secretion.<br />
- reduces interventions to improve lungfunction.<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
Performance<br />
‣ The study started in february 2008 and was<br />
terminated one year later.<br />
‣ 112 patients with neurosurgical or neurological<br />
diagnosis were included.<br />
‣ Randomly 41 patients got heated <strong>humidification</strong><br />
and 71 were treated with HME-filter, these 71<br />
patients served as our controlgroup<br />
‣ Aged varied between 15 – 85 years<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
Inclusion criteria<br />
Exclusion criteria<br />
‣ Patients with<br />
neurosurgical or<br />
neurological diagnosis<br />
‣ Patients nursed > 48<br />
hours and in need of<br />
invasive mechanical<br />
ventilation >12 hours<br />
‣ Patients admitted with<br />
other diagnosis<br />
‣ Patients transfered to<br />
another ICU due to lack<br />
of NICU beds<br />
‣ Patients who died at<br />
NICU.<br />
‣ Patients nursed < 48<br />
hours<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
What data did we use <br />
‣ Glasgow Coma Scale<br />
at arrival to<br />
emergency or NICU<br />
‣ NICU length of stay<br />
‣ Duration of invasive<br />
mechanical ventilation<br />
‣ Performed<br />
bronchoscopies<br />
‣ Bacteria growth<br />
‣ Airway infection<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
GCS on admission<br />
70%<br />
60%<br />
50%<br />
n.s.<br />
n.s.<br />
Humidified<br />
Control<br />
40%<br />
30%<br />
20%<br />
10%<br />
0%<br />
GCS 3-8 GCS 9-15<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
Time spent in NICU<br />
and on ventilator (hours)<br />
n.s.<br />
300<br />
250<br />
200<br />
150<br />
SEM<br />
30,3<br />
SEM<br />
19,8<br />
SEM<br />
23,5<br />
n.s.<br />
SEM<br />
19,0<br />
Humidified<br />
Control<br />
100<br />
50<br />
0<br />
Time in NICU<br />
Time on<br />
ventilator<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
Diagnosed VAP<br />
35%<br />
30%<br />
n.s.<br />
25%<br />
20%<br />
15%<br />
10%<br />
5%<br />
0%<br />
Humidified<br />
Control<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
Conclusion<br />
‣ So the conclusion of our results is that since no<br />
improvements were seen in this patientgroup<br />
concerning NICU length of stay or duration of<br />
invasive mechanical ventilation, the unit is not<br />
going to use heated <strong>humidification</strong> as a standard<br />
procedure.<br />
‣ However benefits were noticed during suctions of<br />
lower airways and broncoscopies due to more<br />
loose secretion.<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011
Thank you for your attention<br />
Tiina Rintala<br />
tiina.rintala@karolinska.se<br />
Helene Karlman<br />
helene.karlman@karolinska.se
Bacteria growth<br />
‣ Controlgroup Humified<br />
Gram-positive coccus: 38 24<br />
‣ Staff aureus, Staff coryne,<br />
‣ KNS.<br />
‣ Streptokock grupp A,B och C<br />
‣ Enterococcus faecalis<br />
‣ Aerococcus urinaae<br />
‣ Gram-negative rods: 53 29<br />
‣ Acinetobacter, E-coli,<br />
‣ Hemofilus influensa, Klebsiella, Pseudomonas, Bacteroides, Enterobacter aerogenes,<br />
enterobacter cloace, Moraxella, Morganella morgani, Serratia marcescens, Prevotella Spices,<br />
Stenotrophmonas,<br />
‣ Candida: 15 8<br />
‣ Candida - dubliniensis<br />
‣ - tropicalis<br />
‣ - albicans<br />
‣ - jästsvamp<br />
Heléne Karlman Tiina Rintala<br />
EfCCNa March 2011