| Objective:To investigate which method is more advantageous in the non-mechanically ventilated patients with tracheotomy by comparing different effects of two methods using heated humidification system or heat and Moisture Exchanger, so that some advice and basis can be gotten in the implementation of nursing path.Methods:62 cases of tracheotomy patients from Intensive Care Unit (ICU) in a Class A Level three comprehensive hospital who met the experimental request were recruited and randomly divided into the experimental group and the control group. Venturi heated humidify system and HME were used in these two groups respectively. Inhaled oxygen temperature, absolute humidity and sputum viscosity at 1 day,3 days, 5days and 7days after therapy were compared between two groups. After 7 days, the respiratory function indexes (including respiratory rate, oxygen saturation, arterial partial pressure of carbon dioxide (PaCO2) and oxygen partial pressure/oxygen concentration (PaO2/FiO2)), complications (sputum crust, irritable dry cough, airway hemorrhage and pulmonary infection), the mean daily suction frequency, humidification cost, hospitalization days in ICU and nurses’ satisfaction towards humidification methods were compared.Result:1. The comparison of the temperature and humidity of inhaled oxygen:Both methods can heat and humidify oxygen consistently within 7 days. On the first day, third day, fifth day and seventh day after intervention, the oxygen temperature and absolute humidity were higher in experimental group than in control group and the difference was statistically significant (P<0.01)2. The comparison of sputum viscosity:There was no statistical difference on the first day, third day, fifth day (P>0.05),whereas on the seventh day. The difference was significant between the two groups (P<0.01). There was significantly different in experimental group between the fifth or seventh day and the first day (P< 0.05),between the seventh day and the third day (P<0.05), whereas there was no statistical difference with each other in control group (P>0.05)3. The comparison of respiratory function:There was no statistical difference with PaCO2 between before and after therapy between both groups or in two groups compared respectively (P>0.05). There was significant difference with SpO2 and PaO2/FiO2 after therapy between both groups and in groups compared respectively between before and after therapy (P<0.05). After oxygen therapy, SpO2, and PaO2/FiO2 were higher than before therapy in both groups, while they were higher in experimental group than in control group. After oxygen therapy, respiratory rate of experimental group was lower than before therapy and lower than control group (P< 0.01), however, there was no statistical difference between before and after oxygen therapy in control group(P>0.05).4. The comparison of complications:There was no difference in total frequency with sputum crust, irritable dry cough, airway hemorrhage and pulmonary infection between the two groups (P>0.05)5. The mean daily suction frequency was lower than before therapy in both groups (P <0.01),which heated humidification system could obviously reduce more of the mean daily suction frequency (P<0.01).There was more satisfaction from nurses in experimental group than in control group (P<0.01); however, there was no statistical difference with humidification cost and hospitalization days in ICU between the two groups (P>0.05)Conclusions:1. Both heated humidification system and HME can maintain the temperature and humidity of inhaled oxygen to a certain extent, while the inhaled oxygen is more similar to body temperature and pressure-saturated (BTPS) with heated humidification system.2. The humidification effect of heated humidification system is better than that of HME with its sputum character improved gradually.3. Heated humidification system is more effective to improve ventilation, maintain the patient’s stable respiration, avoid hypoventilation and increase the effect of oxygen therapy.4. As compared with HME, heated humidification system can reduce more of the mean daily suction frequency, thus, to improve patient’s comfort, to reduce nursing workload and make the nurse’s satisfaction higher.5. The humidification cost is similar of both methods used in short time.In conclusion, heated humidification system can provide oxygen which is similar to patient’s BTPS. It can improve sputum character and the humidification and oxygen therapy effect are improved. It also can make the nurse s satisfaction higher. Compared with HME, the humidification treatment has advantage in the comprehensive evaluation of humidification effect with convenient operation and good safety performance. It is more likely acceptable in clinical nursing. The result also tallies with the domestic application guideline of 2014. |
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