加温加湿と気道管理 人工気道での加温加湿をめぐる諸問題
Contents
1. 1 1 2 3 4 5 6 7 8 9 10 11 1992 pp139 146 1992 pp36 104 1998 15 83 90 International Organization for Standardization Anesthetic and respiratory equipment Heat and moisture exchanger for use in humidifying respired gases in humans ISO 9360 20002. 90 2 5 breath by breath 02 03 3 COz HUMICAP H MOISCOPE OSCAR OXI CO2 COzSMO 5 0 28 0 06 90 90 M a S M Vaisala Datex Novametrix 1 2 M S 4 59 59 2010 5 25
3. 7 3 6 4 heat and moisture exchanger HME Y 7 27 1
4. 3 3 A 1 37C 44mg L g m 47mmHg 47mmHg 4 9mg L 9mg L 9mg L 21 C 25 C 18mg L 23mg L 50 39 2 9mg 1L 1 58 58
5. active humidiier heated humidifier passive humidifer 1 bubble diffusion pass over 2 bubble diffusion pass over MR pass over 60 60 2 MR pass over
6. 5 HME HME Booster 28 31mg L HME BoosterT MEDISIZE 8 5C 7 5mg L Humid HeatTM Gibeck 62 62 _1ex HME L_ a HME lt 8 HME MEDISIZE HME 18
7. absolute humidity AH me L g m3 relative humidity RH partial pressure Pgzo mmHg 57 5 2010 5 25 2 2 1L 2 21C 9mg 9 mg L 25C 37C 9 mg L 3
8. 2 20C 40C 1 20 25 30 35 40 3 20 40 2 20 40 C mg L mmHg 20 17 3 17 5 21 18 3 18 6 22 194 19 8 23 20 6 21 0 24 21 8 22 3 25 23 1 23 7 26 24 4 25 1 27 25 8 26 7 28 27 2 28 3 29 28 8 29 9 30 30 4 31 7 31 32 1 33 6 32 33 4 35 5 33 35 7 37 6 34 37 6 39 8 35 39 6 42 0 36 41 8 44 4 37 44 0 46 9 38 46 3 49 5 39 48 7 52 3 40 51 1 55 1 6 3 G F 37 44mg L G 30C 30 30mg L
9. 1992 pp80 83 Miyao H Hirokawa T Miyasaka K et al Relative humidity not absolute humidity is of great importance when using humidifier with a heating wire Crit Care Med 1992 20 674 679 1126009 1126001 16 11 26 3 2003 pp164 173 Vanderbroucke Grauls CM Teeuw KB Ballemans K et al Bacterial and viral removal efficiency heat and moisture exchange properties of four devices J Hosp Infect 1995 29 45 56 Rosi R Buscalferri A Monfregola MR et al Systemic jithium reabsorption from Iithium chloride coated heat and moisture exchangers Intensive Care Med 1995 21 937 940 Ricard JD Le Miere E Markowicz P et al Efficiency 12 13 14 15 16 17 18 19 20 27 1 and safety of mechanical Ventilation with a heat and moisture exchanger changed only once a week Am J Respir Crit Care Med 2000 161 104 109 Thomachot L Leone M Razzouk K et al Randomized
10. 02 Water Loss ISO EN 9360 100 5
11. HMEF HME 30mg L 24 48 1 3 HME 48
12. MR 210 290 MR 850 410 730 MR410 MR730 850 5
13. relative humidity RH 100 1 1 I 1
14. MR850 MR 290 PEEP MR 210
15. 1996 pp310 313 Lellouche F TailleS Maggiore SM et al Influence of ambient and ventilator output temperatures on performance of heated wire humidifiers Am J Respir Crit Care Med 2004 170 1073 1079 63 63
16. 1L 14mg 100 100 1006 3 3 27 1 4 100 4 100 7 100
17. 3 HMEF CDC 4 CPAP
18. x100 2 1L 9mg 3 B 21C 18mg L C 9 18x100 50 5 2 3 25C 23mg L 37C 44mg L 3 B D 3
19. 1 3 4 HME 6 HUMMAX 0 54mm 32 3 7 61 61 2010 5 25 4 1 CPAP CO2 2 3 4 5
20. 27 1 57 63 2010 I 1 1 37C 21 9mg L 50 32C 30mg L 90 37C 44mg L 100 32C 34mg L 100 33C 36mg L 100 Z 37C 44mg L 100 1 21C 1
21. 5 1 2 35 39C 3 4 5 1 4 5 19 ICU V 5
22. MR 730 RH RH 35 37 RH 0 2 37C 44mg L 37C 44mg L 1 5 MR850 MR850 9 100 cm
23. clinical trial of extended use of a hydrophobic condenser humidifier 1 vs 7 days Crit Care Med 2002 30 232 237 Inspiration 2007 5 5 8 Kirton OC DeHaven B Morgan J et al A prospective randomized comparison of an in line heat moisture exchange filter and heated wire humidifiers Rate of ventilator associated early onset community acquired or late onset hospital acquired pneumonia and incidence of tube occlusion Chest 1997 112 1055 1059 GUIDELINES FOR PREVENTING HEALTH CARE ASSOCIATED PNEUMONIA 2003 Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee Schiffmann H Rathgeber J Singer D et al Airway humidification in mechanically ventilated neonates and infants a comparative study of a heat and moisture exchanger vs a heated humidifier using a new fast response capacitive humidity sensor Crit Care Med 1997 25 1755 1760 Fassassi M Michel F Thomachot L et al Airway humidification with a heat and moisture exchanger in mechanically ventilated neonates A preliminary evaluation Intensive Care Med 2007 33 336 343 ICU CCU 2002 26 405 409 ICU
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