**What Professionals say about the Wright Mask:
“Great job. I’m surprised someone hadn’t invented it before. Upper airway dryness in tracheostomy patients is a real concern. Thanks for inventing this. I’ll mention it to other ENTs I know!” – Dr. James W. Ochi, Children’s ENT, San Diego
“Great innovation to combine both! There hasn’t been enough attention to the sinus cavity and upper airway of tracheostomy patients. The Wright Mask will change that!” – Mathew Bergin, Paramedic, San Diego
“Exactly what our (trached) patients need. This should be fast-tracked everywhere!” – Suzanne Rogers, RN, ENT Clinic, Vancouver, BC Canada
“What an inspiration! Our patients need this!” – Dr. Oscar Terraza, Otorhinolaryngologist, Guatemala
“Our peds need this!” – Dr. Rhonda Homaker, Indianapolis, IN
“Very interesting. Logical. Send me a sample.” – Dr. Norman Harris, Assistant Clinical Professor, Department of Otolaryngology, University of California, Irvine
“Reduce (upper airway) dryness. Reduce re-admittance.” – Dr. Jorge Secin, Buenos Aires, Argentina
“Thank you for inventing it!” – Dr. Andrew Patel, University of California, San Diego, School of Medicine, Department of Otolaryngology – Head & Neck Surgery
**AAP-HNSF 2009 ANNAUAL MEETING & OTO EXPO Oct. 3-7/09 - American Academy of Otolaryngology- Head & Neck Surgery Foundation
Professionals' Write... The Nose & Mouth Need It!
NASAL ADMINISTRATION METHODS STAKE OUT NICHE
A Standout Among Non-injection Routes, Methodology Moves Forward Rapidly
By Alan Smith, Ph.D.
…. As it has long been known that drugs can be absorbed into the systemic circulation through the oral and nasal cavities and lungs, these routes have generated great interest… As these new delivery routes have gained acceptance, technologies have been developed to expand the range of drugs that can be administered… Vaccine deliver is also entering a new era, with alternative delivery modes to traditional injections being developed for both patient convenience and to enhance safety and efficacy.
ADVANTAGES
The nasal route can be used both for local treatment of disease (e.g., allergic rhinitis and nasal congestion) and to administer therapeutic agents for systemic absorption and action… As a route for systemic drug delivery, the nose is readily accessible and is a convenient and noninvasive way to administer drugs… highly vascularized… blood passes from the nose directly into the systemic circulation… nasally administered drugs will be readily absorbed into the bloodstream… providing rapid therapeutic effect…. Nasal administration is particularly attractive when rapid treatment is required for critical medical conditions and where rapid symptom relief is a key aim… additionally, nasal administration avoids exposure to digestive enzymes… Although other non-injection delivery routes claim similar advantages, nasal administration stand out for may reasons. Nasal absorption is faster, more complete, and significantly more convenient… nasal delivery is simpler, is independent of patient technique, and requires less expensive and complex delivery devices… The nasal route provides a means for achieving rapid drug absorption and onset of therapeutic action, and is particularly advantageous for conditions where fast onset of action is needed….The nasal delivery market is expected to continue to expand over the coming years with the arrival of new and improved products.THE FUTURE
Nasal drug delivery has compelling advantages over other delivery methods across drug classes and therapeutic indications. With a large surface area, a highly permeable epithelial membrane…. ready accessibility, the nasal route is seen as a highly promising means for rapid and effective delivery of drugs into the systemic circulation, especially in the treatment of crisis conditions where speed of onset of action is a key requirement… The use of enabling technologies will allow the nasal route to be utilized as a viable alternative to injection for those compounds in the future and also offers exciting opportunities for nasally administered vaccines.
May 15, 2009 – www.genengnews.com – Genetic Engineering & Biotechnology News - Clinical Research & DiagnosticsINFORMATION FOR PATIENTS – HUMIDIFICATION
Your nose and mouth normally warm and moisten the air you breathe. Because you are now bypassing your nose and mouth by breathing through your tracheostomy, you must replace the moisture. Without moisture, your mucus may become thick and hard to cough out. This will make breathing difficult.
2007 University of Pittsburg Medical Center, Pittsburg, PATRACHEOTOMY
AIRWAY MANAGEMENT, COMMUNICATION, AND SWALLOWING
By Dr. Eugene N. Myers & Dr. Jonas T. Johnson
Because the humidification system of the upper airway is bypassed in the patient with a tracheostomy, supplemental humidification is necessary to prevent drying and crusting of the secretions… High humidity can be applied… using a tracheostomy collar… another technique is to instill up to 5 ml of sterile normal saline solution into the tracheostomy tube three to four times daily.
2008 – Second Edition – Plural PublishingNO ADDITIONAL MOISTURE WITH HMEs
HMEs provide adequate levels of humidification for short intervals such as during transport and when active humidity through high flow systems is not practical, but HMEs do not add additional moisture to the airway or breathing circuit. Applying active heated humidity during the course of the day would add the recommended humidity.
References: Wissing, D. R. (2004). Humidity and aerosol therapy. In J. M. Cairo & S. P. Pilbeam (Eds.), Mosby's Respiratory Equipment, Seventh Edition (pp. 87-129). St Louis: Elsevier. Johns Hopkins Medicine – Question & Answers www.hopkinsmedicine.orgGOING HOME WITH A TRACHEOSTOMY
REMEMBER humidification will help your breathing REMEMBER you have a tracheostomy because you have a compromised airway. It is vital to your breathing.
NSCCAHS Health, NSW AustraliaEXTRA HUMIDITY WHEN NOSE & MOUTH BYPASSED
Extra humidity is required because the nose and mouth, which filter, warm, and moisten the air you breathe, are bypassed… Use an ultrasonic nebulizer, a room-size or cool-mist humidifier in your home. Drinking plenty of fluids also helps to keep your airway moist. Increased humidity will be needed during the winter months when your home becomes dry. More moisture is needed whenever secretions become thick, dry, or form plugs. Pink or blood-tinged secretions may also indicate a lack of moisture.
The University of Iowa - UIHC - Dept of Nursing, Iowa City, IowaPRACTICAL VENTILATION- RESPIRATORY TIPS
By Sallie Bitner, MS, RRT
…one’s general state of hydration affects whether the airways are adequately moistened and whether there is enough water in the mucus… All Patients must have humidification to reduce the risk of (Tracheostomy) tube occlusion with secretions. Insufficiently frequent suctioning and/or inadequate humidification are the main causes of tube blockage and respiratory distress… A HME (Heat & Moisture Exchange) device mimics the natural mechanisms of the upper airway although some literature claims that these increase the resistance to breath… Secretions inside the HME can block the filter, increasing the work of breathing, obstructing in inspiration and exhalation.
Nov. 2003 - MDA Chat www.clinicalschool.swam.ac.ukFACE & TRACH MASK 3 TO 4 TIMES DAILY
Reference to nebulizing with a face mask & trachostomy mask notes the treatment be carried out every 2 to 6 hours which is 3 to 4 times daily.
2006 www.rxmed.comPOSTOPERATIVE DETAILS
By Charles E. Morgan, DMD, MD
…. Mucus plugging inner cannula can cause a life-threatening obstructions.
May 2005 - EMedicine - TRACHEOSTOMYOBSTRUCTION
By Dr. Tarum Gera, Dr. Joseph L. Mathew,
… Granulations almost always appear at the site of the stoma, within the tracheal lumen above the stoma. These granulations lead to the obstruction of the tracheal lumen or the tracheostomy tube. The obstruction of the tube or the lumen by a mucus plug can be avoided by adequate humidification and suctioning… The nose and mouth provide warmth, filtering and moisture for the air we breathe. A tracheostomy tube by-passes these mechanisms. Humidification must be provided to keep secretions thin and to avoid mucus plugs.
Dept. Pediatrics, LN Hospital, IndiaTRACHEOSTOMY HUMIDIFICATION
Humidification must be provided to keep secretions thin and avoid mucus.
Aug. 2005 www.2muhealth.orgBYPASSING DECREASE HUMIDIFICATION
Romaine F Johnson, MD
… the physiology of the airway changes significantly (with a tracheotomy). By bypassing the upper airway, you decrease the cough… by bypassing the upper airway, you decrease humidification. That causes thickening of secretions, and stasis. With stasis you get mucosal injury, you get increased risk of infection, crusting, etc.
Mar. 2003 www.bcm.edu/oto/grant/03 - Bobby R. Alford Dept. of Otolaryngology-Head & Neck Surgery, Baylor College of MedicineHUMIDIFICATION
A tracheostomy bypasses the upper airway and therefore prevents normal humidification and filtration of inhaled air. Therefore, unless air inhaled via the tracheostomy tube is humidified, the epithelium of the trachea and bronchi will become dry which increases the potential for blockage.
Patients with a tracheostomy have altered upper airway function and may have increased oral care requirements. Mouth care should be assessed.
Sept. 2008 www.rch.org.au/rchopgEUROPEAN RESPIRATORY SOCIETY GUIDELINES
… The ideal prescription for inhaled therapy would use the simplest and most convenient device.
European Respiratory Journal 2001 - prepared by a European Respiratory Society Task Force on the use of nebulizersAIRWAY MANAGEMENT IN SPECIAL PATIENT POPULATIONS
TRACHEOSTOMY: EASING THE TRANSITION FROM HOSPITAL TO HOME
HUMIDIFICATION
By Lois Dixon, MSN, RN
Adequate humidification of the trachea is very important. Inspired air that bypasss the nose and enters directly through the tracheostomy tube is deprived of all natural moisturizing benefits of the upper airway passages. The importance of humidification in reducing the thickness of secretions and build-up of crusty formations should be discussed with the patient. Symptoms of insufficient humidity include: increased, nonproductive sputum coughing; a change of mucus from thin to a thick, sticky consistency and from clear to pale yellow or other color; shortness of breath from a mucus –plug obstruction; blood-streaked mucus; noisy, labored respirations… The patient with a tracheostomy is also at risk for infection… Bronchopulmonary infections occur because the tracheostomy bypasses the protective upper airway mechanisms such as filtering, warming and humidifying the inhaled air.IMPORTANCE AIRWAY HUMIDIFICATION
The upper respiratory tract of a person during normal breathing, warms, humidifies and filters inspired air from the nose and mouth. The upper respiratory tract is lined by a warm, viscous mucous membrane and as air passes over the membrane, heat and humidity is added to the inspired air before it reaches the lower airways and lungs. This membrane is also lined with very small microscopic cilia, which act as an airway protection mechanism because the cillias constant movement is designed to expel any inhaled contaminants lodged in the airway. When a person exhales, the upper airway also traps most of the heat and moisture in the exhaled breath so that it can be reused during the next inhaled breath. When a person is orally or nasally intubated, the artificial airway bypasses these important mechanisms of heat and moisture exchange that are normally performed by the upper respiratory tract. The loss of this function increases the risk of patient hypothermia, thickening of airway secretions and possible destruction of the airway surface.
www.impactinstrumentation.comHEATED HUMIDIFICATION OR FACE MASK TO PREVENT UPPER AIRWAY DRYNESS DURING CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) THERAPY
.… data indicates that inhaled air dryness during CPAP therapy can be significantly attenuated by heated humidification and can be totally prevented by using a face mask.From the Physiological Sciences Graduate Program, Biomedical Center, Federal University of Espirito Santo (Ms. Martins de Araújo and Dr. Vasquez) and the Unit for Research in Sleep Disorders (UNI-SONO) of Espirito Santo (Dr. Barros Vieira), Vitoria, ES, Brazil, and the Unité de Sommeil, Service de Pneumologie, Hôpital Saint-Antoine (Dr. Fleury), Paris, France www.chestjournal.org
DRYNESS A FREQUENT SIDE EFFECT
Upper airway dryness is a frequent side effect of nasal continuous positive airway pressure (CPAP) therapy in obstructive sleep apnoea (OSA)…. Heated humidification is often used. Alternatively, oily nose drops are frequently applied to relieve dryness. The present study aimed to investigate the efficacy of a heated humidifier or comparison with oily nose drops. 24 OSA patients complaining of serious upper airway dryness were randomized to 6 weeks of treatment either with heated humidification or oily nose drops… All 12 patients treated with heated humidification improved in terms of the degree & frequency of upper airway dryness & great comfort … In contrast only five out of 12 patients (42%) in the oily nose drops group reported their degree of upper airway dryness to be improved… only three patients (25% reported an improvement in the frequency of upper airway dryness and only five patients (42%) reported greater comfort when using…oily nose drops.
2009 Elsevier Respiratory Medicine
Behind the Wright Mask is Dean… Behind the Wright Mask is every Tracheostomy Patient.