Which of the following criteria should be met before considering ...

[melly21297]

Which of the following criteria should be met before considering use of a heat-moisture ex-changer (HME) for a patient being placed on ventilatory support?
 
  1. There should be no problem with retained secretions.
  2. The patient should not have fever (normothermic).
  3. The patient should be adequately hydrated.
  4. The support should be short term (24 to 48 hr).
  a. 1, 2, and 3 only
  b. 2 and 4 only
  c. 1, 2, 3, and 4
  d. 3 and 4 only

Question 2

A patient suffering from postoperative complications has been receiving mechanical ventilation for 6 days with a volume ventilator.
 
  A heat-moisture exchanger (HME) is providing control over humidification and airway tempera-ture. Over the past 24 hr, the patient's secretions have decreased in quantity but are thicker and more purulent. Which of the following actions would you suggest at this time?
  a. Replace the HME.
  b. Switch over to a heated wick humidifier.
  c. Administer acetylcysteine every 2 hr via the nebulizer.
  d. Increase the frequency of suctioning.

[shailee]

Answer to Question 1

ANS: C
Use of HMEs should be avoided in the care of patients with secretion problems and those with low body temperature (<32 C), high spontaneous minute ventilation (>10 L/min), or air leaks in which exhaled tidal volume is less than 70 of delivered tidal volume.

Answer to Question 2

ANS: B
We prefer an optimal humidity approach and use of a heated humidifier to deliver gas in the range of 35 to 37 C at the airway.