Humidification and the HME filter

The process of intubation and ventilation bypasses both the physiological humidification system and protective filtering processes. Various devices have been developed to aid in providing humidification of medical gasses and to serve as filters to reduce transmission of microbes. The following types of devices are available: * Heat and moisture exchanger without filter (HME) * Electrostatic filter with or without HME * Pleated filter with or without HME

Analysis of the fraction of delivered oxygen by noninvasive ventilation devices working as invasive ventilators in pandemic times

Purpose: In the context of the COVID-19 pandemic, mandatory ventilation with noninvasive ventilation (NIV) devices is a valid option when intensive care/anesthesia ventilators are unavailable. The fraction of delivered oxygen (FDO2) by NIV devices in intubated patients is unknown.Method: We simulated intubated patients with normal and sick lungs. NIV was used in pressure control mode with protective lung ventilatory settings. O2 flow was added into the NIV circuit in incremental steps of 1 L/min (from 1 to 15 L). The FDO2 in breathing gases was measured by a paramagnetic O2 sensor placed behind the endotracheal tube. Three NIV circuit options were analyzed: 1) leak at HME filter close to the patient, 2) anesthesia Bain circuit with leak distal to the patient, and 3) leak throughout a non-rebreathing valve near the patient.Results: FDO2 increased proportional to the supplemental O2 flow in all NIV options and in both kinds of patients. The range of FDO2 came from 0.25 to 0.98 in both, healthy and sick lungs. At 5 L/min, FDO2 was 0.53±0.04 and 0.47±0.02 in option 1 and 0.53±0.04 and 0.47±0.02 in option 2 for healthy and sick lungs, respectively. In option 3, 5 L/min of O2 reached 0.84±0.08 in healthy and 0.74±0.09 in sick lungs. Conclusions: In all setups, FDO2 was proportional to the administered O2 flow and it covered the range of FDO2 values commonly observed in ventilated patients.

Adesão ao protocolo de pneumonia associado à ventilação mecânica

RESUMOObjetivo: conhecer a adesão da equipe de enfermagem ao protocolo de pneumonia associada à ventilação mecânica nas Unidades de Terapia Intensiva. Método: trata-se de estudo quantitativo, descritivo, observacional, transversal, em seis Unidades de Terapia Intensiva de um hospital de ensino. Coletaram-se os dados por meio de um checklist à beira do leito. Utilizou-se para análise dos dados o teste de regressão linear multivariada e estatística descritiva e inferencial. Apresentaram-se os resultados em forma de tabelas e figura. Resultados: participaram 945 pacientes com prevalência do sexo masculino, faixa etária 61 a 80 anos, tempo de internação de até 15 dias e incidência de PAV foi 10,58%. A equipe de enfermagem manteve em acordo com o protocolo institucional aproximadamente 90,05% das cabeceiras elevadas de 30º a 45º. Demonstrou-se estaticamente a relação PAV com o sexo masculino, tempo de internação nos primeiros 15 dias e filtro HME. Houve a correlação de cabeceira elevada com idade e tempo de internação e filtro HME com tempo de internação. Conclusão: a equipe de enfermagem coloca em prática o protocolo de prevenção de PAV reduzindo a incidência dessa infecção na unidade. Descritores: Enfermagem; Protocolos; Pneumonia; Respiração Artificial; Unidades de Terapia Intensiva; Ensino.ABSTRACTObjective: to get to know the adherence of the nursing team to the pneumonia protocol associated with mechanical ventilation in the Intensive Care Units. Method: this is a quantitative, descriptive, observational, cross-sectional study in six Intensive Care Units of a teaching hospital. The data was collected through a checklist at the hospital beds. The multivariate linear regression test and the descriptive and inferential statistics were used for data analysis. Results were presented in the form of tables and figures. Results: 945 patients with a prevalence of males, aged 61 to 80 years, hospitalization time of up to 15 days and incidence of VAP were 10.58%. The nursing team maintained in agreement with the institutional protocol approximately 90.05% of the elevated headrests from 30º to 45º. Statistically, the VAP relationship with the male sex, length of hospital stay in the first 15 days and HME filter was demonstrated. There was a high bedside correlation with age and hospitalization time and HME filter with hospitalization time. Conclusion: the nursing team puts the protocol of prevention of VAP into practice, reducing the incidence of this infection in the unit. Descriptors: Nursing; Protocols; Pneumonia; Respiration, Artificial; Intensive Care Units; Teaching.RESUMENObjetivo: conocer la adhesión del equipo de enfermería al protocolo de neumonía asociada a la ventilación mecánica en las Unidades de Terapia Intensiva. Método: se trata de un estudio cuantitativo, descriptivo, observacional, transversal, en seis Unidades de Terapia Intensiva de un hospital de enseñanza. Se recolectaron los datos por medio de un checklist al borde del lecho. Se utilizó para análisis de los datos la prueba de regresión lineal multivariada y estadística descriptiva e inferencial. Se presentaron los resultados en forma de tablas y figura. Resultados: participaron 945 pacientes con prevalencia del sexo masculino, grupo de edad 61 a 80 años, tiempo de internación de hasta 15 días e incidencia de PAV fue 10,58%. El equipo de enfermería mantuvo de acuerdo con el protocolo institucional aproximadamente el 90,05% de las cabeceras elevadas de 30º a 45º. Se demostró estáticamente la relación PAV con el sexo masculino, tiempo de internación en los primeros 15 días y filtro HME. Hubo la correlación de cabecera elevada con edad y tiempo de internación y filtro HME con tiempo de internación. Conclusión: el equipo de enfermería pone en práctica el protocolo de prevención de PAV reduciendo la incidencia de esa infección en la unidad. Descriptores: Enfermería; Protocolos; Neumonía; Respiración Artificial; Unidades de Cuidados Intensivos; Enseñanza.