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Tracheostomy Suctioning Essay

4166 words - 17 pages

HUMIDIFICATION
Claudine Billau
The formation of a tracheostomy significantly alters the patient’s respiratory
physiology. In bypassing the upper respiratory tract, the patient is more
susceptible to changes in humidity and there is a consequential change in the
function of the respiratory mucosa. Understanding these changes is fundamental to managing these patients effectively (see Chapter 1, Anatomy and
Physiology of the Respiratory Tract).
NORMAL MECHANISM OF HUMIDIFICATION
The upper respiratory system: the nose, pharynx, larynx and the trachea
(Fig. 1), normally provides an effective system for conditioning inspired
gases. As well as acting as a filter for foreign particles and ...view middle of the document...

At this point the inspired gasesare said to have reached alveolar conditions. This point is known as the
Isothermic Saturation Boundary (ISB).3
Under normal conditions this point
is approximately 5 cm below the carina. This point remains relatively constant, even with the extremes of environmental conditions.3,4 However as the
result of disease processes, or in the presence of a tracheostomy the ISB can
be shifted downwards. This places the burden of heat and moisture exchange
upon the lower respiratory tract, a job to which it is poorly suited. This burden is further increased by the delivery of cold, anhydrous medical gases, such
as oxygen.2–4 The loss of heat and moisture from the respiratory mucosa has
the potential to lead to damage of the respiratory epithelium itself.5
Humidity is the amount of water vapour transported by air or other gases;
it can be either absolute or relative. Absolute Humidity (AH), is the mass of
water held by a volume of gas, where as Relative Humidity (RH) describes, as
a percentage, the water vapour content compared to the maximum water
vapour that could be held at that given temperature. When the water content
is at its maximum, at a given temperature, the gas is saturated.6
This occurs
144
TRACHEOSTOMY: A MULTIPROFESSIONAL HANDBOOK
Epiglottis
Vocal cords
Oesophagus
Trachea
Carina
Bronchus
Alveoli
Bronchioles
Lung
Tongue
Nose
Fig. 1: Respiratory anatomy (courtesy of Mallinckrodt).under normal conditions at the ISB. Appropriate conditioning of inspired
gases is vital to facilitate oxygen exchange in the alveoli.
On expiration, heat is transferred from the alveolar gas at 37C and 100% RH
to the cooler upper respiratory mucosa. Air leaves the nose at approximately
32C on expiration. As gases cool, their capacity to hold water vapour is
reduced. It is at this point that condensation occurs. This in turns leads to a
further cooling of the gases due to loss of latent heat of vaporisation.7
This
heat is then transferred back into the respiratory mucosa. The mucosa is thus
rewarmed and rehydrated (see Figure 2). The maintenance of this warm and
moist environment ensures optimal function of the respiratory tract and its
epithelium. The nose and upper respiratory tract act as a counter current heat
and moisture exchanger (HME), ensuring that inspired gases are conditioned
and cleaned, while retaining heat and moisture on expiration.8
Maintenance
of the correct balance between temperature and relative humidity in the
upper airway is important to maintain effective function.9
In the presence of a tracheostomy the upper respiratory tract is bypassed.
This can lead to a shift in the ISB further down the respiratory tract. If the
patient is receiving supplementary oxygen therapy the demands on the
HUMIDIFICATION
145
Fig. 2: Human air conditioning (courtesy of Tyco).natural heat/moisture exchange system are further increased. In order to prevent the adverse effects of under...

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