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Blood Pressure The Silent Killer
Somone Baskett
English 1020 – English Composition
Virginia Collage, Surgical Technician Program
Augusta 22, 2017
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Blood Pressure The Silent Killer
The treatment of Hypertension is a complex approach that involves nutrition, exercise and
medications. Nutrition is one of the major factors in hypertension, an unhealthy diet is the cause
of the disease. Healthy eating can prevent hypertension. A “colorize diet” fruits and vegetables
are recommended for patients. (Kushner, 2006) Preventive nutrition with the plate method and
portion control low sodium meals will stop hypertension. High fat diets can cause a person to
have a heart attack or a stroke.
“The association of serum uric acid (SUA) with the risk of hypertension is controversial
and may be modulated by lifestyle factors. We did a prospective study to investigate whether
SUA was an independent predictor hypertension in the young and whether physical activity
influences this association.” (NewsRx, 2017) Exercise may counteract the mechanisms involved
in the association of hypertension. Regular physical activity on a daily bases thirty to forty-five
minutes a day can reduce the chances of hypertension. Research study shows that “exercise may
counteract future hypertension” 2017 FEB 25 (NewsRx) according to the news editor. With this
being stated and results from research has come back conclusively showing physical activity can
counteract hypertension.
Medication is for patients who has been diagnosed with hypertension. Awareness is the
key to your health issues. Patients must be educated after being diagnosed. Blood pressure must
be monitored and blood pressures greater than 140 systolic and greater than 90 diastolic or equal
to will be identified as having hypertension. Treatment for the patient is required usually an
antihypertensive medication. Study shows “antihypertensive use was significantly higher among
females in the urban areas compared with females living in rural areas (76% urban vs. rural 63%,
p < 0.05) non -working males were more likely to use antihypertensive medications compared
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Blood Pressure The Silent Killer
with working males (76 vs 60%, p 0.003).” (Muntasirur Rahman, (May 25, 2017)) Medication
should be used on a daily bases and very important to your health. Most hypertension medication
has a water pill installed. For instance Lisinopril 20/25 this is a form of Lasix in it. This will help
lower your blood pressure by getting rid of water retention.
In conclusion, the treatment of hypertension is a complex approach that involves
nutrition, exercise and medication. Controlling your portions and eating a healthy well balanced
low fat diet and incorporating exercise daily you will prevent hypertension. Medication for
treatment if you have hypertension is very important to take on a daily base. Education is
knowledge so get educated and know your status. See a doctor for regular check- ups.
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Blood Pressure The Silent Killer
References
Researchers at University of Padova (L. Mos, 2017) (L. Mos, 2017) Report Findings in Hypertension
(Regular physical activity prevents development of hypertension in young people with
hyperuricemia). (2017, February 25). Obesity, Fitness & Wellness Week, 1757. Retrieved from
http://go.galegroup.com.prxvc.lirn.net/ps/i.do?p=AONE&sw=w&u=lirn59592&v=2.1&it=r&id=GALE%7CA481745172&a
sid=9abd9f1f7130b996f931c65256af5cf8
Rahman, M., Williams, G., & Al Mamun, A. (2017). Gender differences in hypertension awareness,
antihypertensive use and blood pressure control in Bangladeshi adults: findings from a national
cross-sectional survey. Journal of Health, Population and Nutrition, 36(1). Retrieved from
http://go.galegroup.com.prxvc.lirn.net/ps/i.do?p=AONE&sw=w&u=lirn59592&v=2.1&it=r&id=GALE%7CA492895257&a
sid=ae770e8ba06838d2917d884912949398
ALL INTUBATED PATIENTS SHOULD USE ACTIVE HUMIDIFICATION
All Intubated Patients Should Use Active Humidification
Courtney Johnson
ENG1020-English Composition II-XD,
Virginia Collage, Respiratory Therapy Program
Author Note
1331 Old Cahaba Cove, Helena, Alabama 35080
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ALL INTUBATED PATIENTS SHOULD USE ACTIVE HUMIDIFICATION
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To provide the needed heat and moisture to an intubated patient’s airway, a Respiratory
Therapist should always use active humidification. A patient’s pulmonary capillary bed requires
all inspired gas to be at 37° Celsius (C) and at 100% Relative Humidity (RH) or airway damage
will occur. When a patient is intubated and the endotracheal tube bypasses the nose and upper
airway, the body cannot heat and humidify its own inspired air as normal. Active humifaction
uses a passover heater/humidifier and a heated wire circuit, can servo control inspired gas at 37°
C and 100% RH. Passive humidification captures the body’s own heat and humidification in a
Heat Moisture Exchanger (HME) as the patient exhales through the HME. As the patient inhales
the HME heats the inspired gas to 35° C and 100% RH. 1 HMEs can only provide a partial
amount of the needed heat, to ensure critical heat and humidification to the patient’s airway the
RT should always use active humidification. A major function of the upper air airway is to
condition inspired air to 37°C at 100% relative humidity, or 44 mg/L of water Absolute
Humidity(AH). The inspired gas normally reaches this conditioned state at 5 cm below the
corunna, this theoretical point is called the Isothermic Saturation Boundary. A mechanically
ventilated patient with an Endotracheal Tube (ETT) in place bypasses the patient’s airway
natural conditioning gas process. The gas exits the ETT just above the Isothermic Saturation
Boundary, therefor all gas delivered by a ventilator should be heated and humidified by the
Respiratory Therapist. According to the American Association for Respiratory Care(AARC)
Clinical Practice Guidelines(CPC)(Restrepo & Walsh, 2012) there are two main way gas should
be conditioned, “active humidification through a heated humidifier (HH) and passive
humidification through a Heat and Moisture Exchanger (HME).” Active Heated Humidifier
(HH) uses a ventilator (vent) circuit with internal heated wires and a servo controlled heater. The
ALL INTUBATED PATIENTS SHOULD USE ACTIVE HUMIDIFICATION
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heater warms a set amount of water to a predetermined temperature. The heated water produces
both heat and humidity. As the gas moves through the vent circuit, the heated gas would
normally cool to the surrounding room temperature. The heated wires inside the vent circuit are
servo controlled to heat up as needed to maintain the gas at the preset temperature. The heated
wires keep the gas heated and humified until the gas is delivered to the EET. Depending on
manufacture type, active humidifiers can be set to servo control to many different temperatures
including 37° at 100% relative humidity. Heat and Moisture Exchangers (HME) are also known
as artificial noses. HME are place between the vent circuit and the ETT. The HME is made of
filter like materteral that captures the patient’s exhaled heat and moisture. During inspiration, the
HME passively releases the heats and moisture back to the cold dry gas inspired gas. According
to the AARC’s CPG (Restrepo & Walsh, 2012);
“The American National Standards Institute recommends absolute humidity (AH)
values of ≥ 30 mg H2O/L; the American Association for Respiratory Care (AARC) has
recommended AH values of ≥ 30 mg H2O/L, while the ISO prefers AH values of ≥ 33
mg H2O/L. A HME that delivers 26 –29 mg H2O/L may be adequate for patients without
underlying conditions that impair airway clearance18,19; however, HMEs that provide an
AH 26 mg/L should not be used. The use of HMEs that deliver an AH of at least 30 mg
H2O/L are recommended, as they are associated with a lower incidence of ETT
occlusion.”
The AARC’s CPG of 2012 have no contraindications to active humidity. There are
multiple hazards and contradictions for use of an HMEs. Even though Active Humidity provides
greater Absolute Humidity that the Passive Humidity of a HME, neither the AARC, Restrepo,
and Walsh state a position of which they prefer the bedside Respiratory Therapist to use.
ALL INTUBATED PATIENTS SHOULD USE ACTIVE HUMIDIFICATION
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A patient on mechanical ventilation not receiving conditioned gas at 37°C at
100% RH or 44 mg/L of water AH, can quickly begin to produce thick mucous and thick
secretions. According to Tucci (2015) low heat and humidity can cause lung damage by
“promote lung injury through production of mediators, such as pro-inflammatory
cytokines, which participate in recruitment/activation of inflammatory cells, induction of
alveolar cell death, and disruption of the alveolar capillary barrier. This mechanism is an
important component of the physiopathology of ventilator-induced lung injury and of
some airway diseases, such as COPD and asthma”.
This lung damage can last long after the patient is no longer on the ventilator.
Conditioning ventilator gas by the RT may be seen as a daily mundane task. But the RT should
insure the ventilated patient continuously receives the maximum amount of heat and humidity at
all time with on the ventilator.
Everyone agrees there is a need to condition the inspired gas of mechanically
ventilated patient. But there is no agreement on how this should be accomplished. This important
decision is not mandated by the AARC, RT staff, or even the Attending Physician. According to
Diiulio (2015) How inspired gas is condition is “Typically, the policy within the RT Department.
Some institutions are all active or all passive. Some places use passive HMEs for short-term
patients and switch to an active device after ‘x’ amount of hours or days. It varies across
facilities.” When asking RTs witch they prefer, the subject may evoke a heated debate from some
RTs. Some may feel very strong for HME, other for HH. When asked why they use HME or HH
the reasons may vary from RT to RT. Depending on the RT, their reasoning may be based on
science, history, or simply “it is the RT policy.”
ALL INTUBATED PATIENTS SHOULD USE ACTIVE HUMIDIFICATION
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One of the reasons for the controversy on what heat and humidity systems are best
to use, because there is no gold standard for measuring heat and humidity during studies.
According to Cuquemelle and Lellouche (2013) stated that “different methods may provide large
over-estimates, up to 8.9 mg H2O/L.” These variations in heat and humidity reading may show
up in different studies comparing equipment or patient readings. The authors Cuquemelle and
Lellouche preformed their own study using both HMEs and HHs. Their study had two arms with
44 patients, with 22 on HHs and 22 on HMEs. Cuquemelle and Lellouche preformed their study
using the International Standards Organization (ISO) standard for humidification device testing.
Their study showed HH delivers the most constant humidity to the patient airways. In the test,
HMEs did not deliver the required heat and humidity needed by the mechanically ventilated
patient. As other less rigorous studies have shown, HMEs do not provide the required heat and
humidity to the mechanically ventilated patient. This shows that all patients on the vent should
be on active humidification.
Everyone agrees, all Respiratory Therapists must heat and humidify the gas delivered by
their ventilators. Even though the Respiratory Therapists, RT Managers, RT Departments, nor the
AARC cannot agree that active or passive humidity is superior. The physics of heating and
humidifying should be clear to everyone, passive humidification cannot provide gas at 37°C at
100% relative humidity. Active humidity is the only system that guarantees proper heat and
humidity all the time and in every circumstance. To insure all intubated patient are receiving the
needed heat and humifaction, the Respiratory Therapist should use active humidification on all
ventilated patients. As a professional and caring Respiratory Therapist, why would you pick
anything other than active humidity?
ALL INTUBATED PATIENTS SHOULD USE ACTIVE HUMIDIFICATION
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References
1) AARC Clinical Practice Guideline Humidification During Invasive and Noninvasive
Mechanical Ventilation: 2012. Ruben D Restrepo MD RRT FAARC and Brian K Walsh
RRT-NPS FAARC
2) Humidification during ventilation: one size doesn't fit all. Diiulio, Renee. RT (Online);
Los Angeles Los Angeles: Anthem Media Group. (Nov 1, 2014)
3) Humidification during invasive mechanical ventilation: less lung inflammation with
optimal gas conditioning Mauro R. Tucci and Eduardo L.V. Costa Respiratory Care.
60.12 (Dec. 2015): p1854.
4) Assessment of humidification performance: still no easy method! Elise Cuquemelle
and Francois Lellouche. Respiratory Care. 58.9 (Sept. 2013) p1559. Word Count: 1722.
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