The therapist is working with a mechanically ventilated patient who has a heated wire breathing circuit attached to a heated humidifier. The therapist has noticed that this patient's mucus has progressively gotten thicker over the last 5 hours. What can account for this situation?
A. a heated humidifier temperature of 50o C, and a heated wire circuit temperature of 37o C
B. a heated humidifier temperature and a heated wire circuit temperature of 37o C
C. a heated humidifier temperature of 32o C, and a heated wire circuit temperature of 40o C
D. a heated humidifier temperature of 50o C, and a heated wire circuit not heating at all
?ANS: C
A. Incorrect response: Sufficient humidification will be provided to this patient to maintain airway humidification. Condensate will form inside the breathing circuit.
B. Incorrect response: The patient should receive adequate humidification in this situation. Little condensate will form inside the breathing circuit.
C. Correct response: The gas leaving the heated humidifier will have a relative humidity of 100%, as it carries 33.8 mg of water per liter of air at 32o C. However, the heated wire circuit is set at a higher temperature (37o C), and will increase the air's capacity to hold water. At that temperature, the air has a capacity to hold 43.8 mg/L. Consequently, no source of humidification is present other than the patient's respiratory mucosa, which will render moisture to the inspired air to compensate for the humidity deficit.
D. Incorrect response: Having a heated humidifier operating at a temperature of 50o C, and having a heated wire circuit not heating at all, is commensurate with a situation wherein a heated humidifier is in use without a heated wire circuit. In both of these situations, the air leaving the heated humidifier is 100% humidified. As the gas flows through the unheated breathing circuit, it cools, has a lower capacity to hold water, and produces condensate in the tubing. By the time the gas reaches the patient's airway, the gas should be at or near 37oC, thereby minimizing the humidity deficit. The therapist must be vigilant with attending to emptying the condensate from the breathing circuit in such situations.
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