Is humidification necessary?
Is humidification necessary?
Is humidification necessary?
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<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
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