الفهرس 
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Abstract
The upper airway loses its function of warming and humidifying the inhaled air during inspiration after the artificial airway is established, resulting in increased water loss of the lower respiratory tract, mucosal drying, secretion drying. Heating and humidification can make the cilia of the tube wall move actively and continuously push up the mucus attached to the cilia, which is conducive to discharge. As a result, during mechanical ventilation (MV), humidification and warming of inspired gases is a key concern. Heat humidifiers (HH) and heat moisture exchangers (HME) are the two types of humidifiers typically utilized in clinical practice.
Aim of this study:
The current study was conducted to assess the effect of using heated humidifier (HH) versus heat moister exchangers(HMEs) on tracheobronchial secretion and body temperature among mechanically ventilated patients.
Materials & Method:
A quasi experimental research design was utilized to accomplish this study. This study was carried out in general ICUs at the Damanhur Medical National institute which was classified to general ICU I(15bed) and the general ICU II (13bed).
A convenience sample of 60 adult mechanically ventilated patients from starting day of invasive mechanical ventilation(IMV) will be included in the study. To accomplish the aim of the current study; one tool was used for data collection “Humidification outcomes assessment tool”. This tool was developed by the researcher after reviewing the relevant literature, except part II was adopted from Gross &Park, 2012.It consists of five parts: Part I: ”Patients’ characteristics”,it included patients’ demographic data such as age and sex, patients’ clinical data such as current diagnosis, and past medical history. Part II: ”Tracheobronchial secretion assessment”, it consists of three types of secretion thin, moderate and thick. Scoring system of this tool mean: no secretion=1, thin=2, moderate = 3, thick=4.Part III: ”Airway obstruction assessment ”,this part included the signs of airway obstruction for patients on MV includes: patients’ data such as partial pressure of arterial oxygen (PaO2), partial pressure of arterial carbon dioxide (PaCO2), arterial oxygen saturation (SaO2), use of accessory muscles of breathing; air entry and breath sounds over a region of the chest, and number of endotracheal tubes changed. Ventilator data such as peak airway pressure (P peak), minute volume, Y-shape temperature and humidity. Part IV:” Physiological response to humidification assessment ”,it included physiological parameters as heart rate, blood pressure, respiratory rate and rectal temperature. Part V: ” factors affecting efficiency of humidification ”,it included room temperature, fluid balance, and current intake of mucoactive drugs.
The study design was accomplished as follow:
An approval from the ethical committee, Faculty of Nursing was obtained. An official permission was obtained from the Faculty of Nursing Alexandria University to the administrative authorities of the Damanhur Medical National institute to conduct the study. An official approval was obtained from the hospital administrative authorities to collect the necessary data from the selected settings after explanation of the aim of the study. The study tool tested for content validity by 5 experts in the field of the study. The necessary modifications were done accordingly. Reliability of the tool was measured using Cronbach Alpha reliability, the reliability coefficient values was (r =0.932) which is acceptable.
Data were collected by the researcher during approximately four months starting from July 2020 to October 2020.All newly admitted critically ill patients were assessed by the researcher for meeting the inclusion criteria on the first day of MV and reevaluated daily for the exclusion criteria over one week. They assigned into two intervention groups.group (A) the study group who subjected to pass over HH without heated wire in the units based on AARC guidelines. group (B) the study group who subjected to HMEs with antibacterial filter in the units based on AARC guidelines.
Patient’s characteristics and clinical data were assessed for each patient in the both groups,and was recorded using part I of the study tool. Tracheobronchial secretions viscosity was assessed for each patient in the both groups. The data was recorded using part II of the study tool. Signs of airway obstruction were assessed for each patient in the both groups to determine the effect of humidification devices on the occurrence of artificial airway obstruction in-addition to Y-shape temperature and Y-shape humidity. The data was recorded using part III of the study tool. Physiological responses to humidification devices were assessed for each patient in the both groups, then recorded by using Part IV of the study tool.Room temperature, fluid balance and current intake ofmucoactive drugs were recorded, data was recorded using Part V of the study tool.
Results of the current study were as follow:
Most of the studied patients were males; aged 51 ≥ 60years old. The findings of the present study show that there was no statistically significant difference between the two groups regarding sex, age current diagnosis and medical history (p=0.59, 0.24 ,0.64 and 0.85 respectively).
Regarding tracheobronchial secretion viscosity, the majority of study sample in HH group had thin secretion viscosity that represents (63.3%) compared to more than half of study sample in HMEs group had moderate secretion viscosity that represents (53.3%). There was statistically significant difference between the two studied groups regarding tracheobronchial secretion viscosity (p=0.005).
There was no a statistically significant difference between the two groups regarding Pao2, Paco2 and Sao2 (p= 0.306, 0.866, and 0.539 respectively).
There was a statistically significant difference between the two groups regarding air entry, breathing sounds, and use of accessory muscles (p= 0.031, 0.040, and 0.030 respectively). There was no statistically significant difference between the two groups regarding frequency of endotracheal tube changed (p= 0.095).
There was a statistically significant difference between the two groups regarding P peak, Respiratory rate, Y-shape humidity, And Y-shape temperature (p= 0.005, 0.006, <0.001 and<0.001respectively). There was no statistically significant difference between the two groups regarding minute volume (p= 0.788).
It can be observed there was no statistically significant differences between the two groups regarding heart rate, first, second rectal temperature, systolic and diastolic blood pressure (p=0.707, 0.8170,110, 0.195, and0.212 respectively).
In relation of current intake of mucoactive drugs, most of studied samples in both group use mucoactive drugs that represent 80% in HH group compared to 93.3% in HMEs group, with no statistically significant difference.
In HH group there was no statistically significant relation between endotracheal tube changed and tracheobronchial secretion viscosity (p=0.431). On contrary, there was statistically significant relation between intake of mucolytic drugs and tracheobronchial secretion viscosity (p=0.038).
In HMEs group there was statistically significant relation between endotracheal tube changed and tracheobronchial secretion viscosity (p=0.033). There was no statistically significant relation between intake of mucoactive drugs and secretion viscosity (p=0.242).
As regarding correlation between Y-shape temperature ,2nd rectal temperature between the two-studied groups. There was statistically significant correlation between Y-shape temperature and rectal temperature in HH group (r=-0.390). There was no statistically significant correlation between Y-shape temperature and rectal temperature in HMEs (r=-0.023).
Conclusion
Based on the findings of the current study, it can be concluded that:
Most of HH patients had thin tracheobronchial secretion and less airway obstruction when compared with HMEs patients.
Recommendations
• Emphasis on presence of HH with suitable water level, and how to measure the inspired air temperature and humidity that delivered by it.
• Develop educational programs and workshops to raise critical care nurse (CCNs) awareness regarding benefits of artificial humidification for patients with invasive mechanical ventilation.
• Provide guidelines about steps of HH use, and how to cover any default that occur during use.
• Conduct protocols to reduce the incidence of tube blockage and for early identification.
• Formulate evidence-based guidelines and standards of airway humidification for mechanically ventilated patients.
• Replication of the current study on large sample, longer duration of data collection and different settings for generalization of the results.