Ultrasonic humidifiers are commonly used in households to maintain indoor humidity and generate a large number of droplets or spray aerosols. However, there have been various health concerns associated with humidifier use, largely due to aerosols generated during operation. Here, we investigated the size distribution, chemical composition, and charged fraction of aerosol particles emitted from commercial ultrasonic humidifiers. Heavy metals in water used for humidifiers were found to be highly enriched in the ultrasonic humidifier aerosols (UHA), with the enrichment factors ranging from 102 to 107. This enrichment may pose health concerns for the building occupants, as UHA concentrations of up to 106 particles/cm3 or 3 mg/m3 were observed. Furthermore, approximately 90% of UHA were observed to be electrically charged, for the first time according to our knowledge. Based on this discovery, we proposed and tested a new method to remove UHA by using a simple electrical field. The designed electrical field in this work can efficiently remove 81.4% of UHA. Therefore, applying this electrical field could be an effective method to significantly reduce the health risks by UHA.

Ngari Prefecture, Tibet, China, features its ultrahigh altitude above 4200 m, very little annual precipitation and extremely low relative humidity. Residents who have migrated to Tibet from the plains use indoor humidification to reduce the respiratory discomfort caused by prolonged exposure to dry indoor air. In this study, field investigations and analysis of residential indoor environments and humidification methods in Ngari Prefecture revealed that ninety-eight percent of humidifier consumers in the prefecture used low-cost ultrasonic humidifiers filled with indoor tap water. The results revealed that the arsenic (As) concentration of the tap water was 41.6 μg/L, over four times China\'s standards for drinking water quality (10 μg/L). The source As concentration in the air humidified by the tap water-filled ultrasonic humidifier is (619.8 ± 59.1) (ng/m3 ·air), while no As was detected in the air humidified by the evaporative humidifier. For ultrasonic humidifier with tap water-filled, the inhalation dose of a healthy adult was 45.4 ng/d. The minute ventilation volume of migrated residents who had been in Ngari for less than two years (12.5 ± 4.3 L/min) was greater than those of the long-term residents (10.0 ± 4.5 L/min), which may exacerbate the short-term inhalation exposure risk for migrated residents. To reduce the health risks associated with As exposure, evaporative humidifiers are recommended for households using domestic water. If ultrasonic humidifiers are used, the tap water must be purified with terminal filters.

Oral feeding of water cannot be accomplished in some critical patients due to coma, mouth-breathing or long-term indwelling of gastric tube, causing dry mouth which results in oral pain, ulcer, or infection, aggravating patients\' discomfort and even affecting the prognosis. To solve this problem, the medical staff of the First Hospital of Jiaxing developed a novel oral humidifier and obtained the National Utility Model Patent of China (ZL 2019 2 0066979.0). The oral humidifier consists of a spraying device and a fixation device. The spraying device is a spraying housing with a water tank, and a spraying port where nanometer water mist can be emitted. The spraying housing is also equipped with a flashlight with a switch, and a schematic diagram of pupil size, which can be used to assess the pupil size conveniently. The fixing device is composed of a fixing frame, an adjustable rod and a clamp. The two ends of the adjustable rod are connected to the fixing frame and the clamp respectively, and can be adjusted to proper shape. The spraying housing can be placed on the fixing frame and installed on the bed and adjusted to the proper position quickly. This novel oral humidifier is a simple device which combines a spraying system with a pupil evaluation tool, implying significant clinical application in improving the convenience of nursing and alleviating dry mouth of critical patients.

BACKGROUND: Airway humidification methods are commonly used in clinical practice, but no clear consensus exists on which particular method is best suited for specific clinical conditions.
METHODS: In this retrospective study, we carried out a quantitative evaluation of three methods commonly used for patients with severe traumatic brain injury (STBI). We recruited 150 patients who received airway humidification after tracheotomy. Subjects were divided into three groups according to the humidification method they received which included oxygen atomizer (OA) group, heat and moisture exchangers (HMEs) group, and heated humidifiers (HHs) group. Variables including phlegm viscosity, humidification effects, phlegm formation rates, daily sputum inhalation times, airway spasm, secondary lung infections, daily nursing load, and evaluation of nurse job satisfaction levels were documented.
RESULTS: Results indicated that the OA tended to cause either insufficient or excessive humidification, whereas phlegm scab formation was significantly reduced in HHs. HMEs and HHs displayed equal humidification effects, and a similar daily sputum induction and consequent nursing load. Airway spasm was a frequent occurrence in OA. The severity, but not the infection ratio, of secondary infection decreased significantly in HHs by the 30th day. The OA significantly reduced nursing load, but demonstrated the worst humidification effects.
CONCLUSIONS: Overall results suggested that the HHs is more suitable for airway nursing of STBI patients who are bedridden for extended periods.

BACKGROUND: This study uses a method of systematic evaluation to evaluate the safety and effectiveness of heated humidified high-flow nasal cannula (HHHFNC) as an initial ventilation method in the treatment of neonatal respiratory distress syndrome (NRDS) scientifically. In the field of evidence-based medicine, this study provides a theoretical reference and basis for choosing appropriate initial non-invasive ventilation methods in the treatment of NRDS, thereby providing assistance for clinical treatment.
METHODS: The main electronic network databases were searched by computer, including 4 Chinese databases: CNKI, WangFang Data, CQVIP, SinoMed and 3 English databases: PubMed, The Cochrane Library and EMBASE, the time range of retrieval from the beginning of each database to September 1, 2020. The content involves all the published randomized controlled trials on the effectiveness of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. Using a search method that combines medical subject words and free words. Based on the Cochrane risk bias assessment tool, 2 researchers independently screen the literature, and then extract the data we needed in the literature, and cross-check. If it is difficult to decide whether to include literature, then turning to a third researcher for help and making a final decision after discussion, and using RevMan 5.3 and STATA 13.0 to analyze the relative data.
RESULTS: Based on the method of meta-analysis, this study analyzes the pre-determined outcome indicators through scientific statistical analysis, and compares the effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS. All results will be published in peer-reviewed high-quality professional academic journals.
CONCLUSIONS: Based on evidence-based medicine, this study will obtain the establishing evidence of comparison that the clinical effectiveness and safety of HHHFNC compared with NCPAP as an initial ventilation method in the treatment of NRDS through the existing data and data, which provides the evidence support of evidence-based medicine in the treatment of NRDS.
UNASSIGNED: September 17, 2020. osf.io/f6at4 (https://osf.io/f6at4).

Airway humidification is an important treatment for tracheotomy patients. At present, the commonly used methods of humidification are atomization inhalation, intra-tracheal drip, etc., but most of them have the disadvantages of interrupted humidification, inadequate humidification, repeated exposure of airway, increased nursing workload, etc. An improved disposable atomizer was designed by the emergency department of Jiaxing First Hospital in Zhejiang Province, which solved the above problems and obtained the National Utility Model Patent of China (ZL 2014 2 0406688.9). In the traditional atomizer, a make-up pipeline is added to run through the liquid container. The replenishing pipe is connected with an external infusion device. At the end of the pipeline inside the liquid container, a buoy with a guide rod is designed to continuously add liquid and automatically control the make-up speed. The device is driven by oxygen to perform airway humidification. The design can keep sufficient airway humidification, avoid frequent addition of humidification fluid, achieve the effect of increasing humidification, reducing the occurrence of complications, increasing the comfort of patients, and reducing the workload of nursing, and has a certain clinical value.

Transnasal pulmonary aerosol delivery using high-flow nasal cannula (HFNC) devices has become a popular route of aerosol administration in toddlers. Clinically, albuterol is administered using an infusion pump or unit doses. However, little evidence is available to compare the two administration strategies.
A toddler manikin (15 kg) with appropriate anatomic airway was connected with collecting filter to a simulator of distressed breathing. HFNC device with mesh nebulizer placed at the inlet of a humidifier at 37°C, with the gas flow set at 25 and 3.75 L/min. Five milligrams of albuterol was delivered in all experiments. With infusion pump administration, albuterol concentrations of 5 and 1 mg/mL were delivered at 4 and 20 mL/hr for 15 minutes. With unit dose administration, 1 mL (5 mg/mL) and 2 mL (2.5 mg/mL) of albuterol were nebulized. Additional tests with mouth open and nebulizers via mask were using 5 mg/1 mL for mesh nebulizer and 5 mg/3 mL for jet nebulizer (n = 3). The drug was eluted from the filter and assayed with UV spectrophotometry (276 nm).
The inhaled dose was higher with unit dose than infusion pump administration with gas flows of 25 L/min (2.66 ± 0.38 vs 1.16 ± 0.28%; P = .004) and 3.75 L/min (10.51 ± 1.29 vs 8.58 ± 0.68%; P = .025). During unit dose administration, compared with closed-mouth breathing, open-mouth breathing generated a higher inhaled dose at 3.75 L/min and lower inhaled dose at 25 L/min. Compared to the nebulizers via mask with both open and closed-mouth breathing, nebulization via HFNC at 3.75 L/min generated greater inhaled dose, while HFNC at 25 L/min generated lower inhaled dose.
During transnasal aerosol delivery, the inhaled dose was higher with medication administrated using unit dose than using an infusion pump.

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OBJECTIVE: Upper airway symptom associated with continuous positive airway pressure (CPAP) treatment is an important factor influencing CPAP adherence. There are conflicting data on the effect of a heated humidifier (HH) during CPAP titration for patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study investigated the effects of HH during CPAP titration in the cool sleeping environment.
METHODS: Forty newly diagnosed OSAHS patients who received CPAP titration in the cool sleeping environment were randomly assigned to HH and non-HH groups. A questionnaire was used to evaluate upper airway symptoms, satisfaction with initial CPAP treatment, and willingness to further use CPAP. Some therapy parameters including leak, apnea hypopnea index (AHI) reduction, and optimal CPAP pressure level were analyzed. We compared these subjective and objective data between the two groups.
RESULTS: In subjective sensation, the use of HH can alleviate upper airway symptoms associated with CPAP titration (P < 0.001). The HH group has benefit in satisfaction with initial CPAP treatment (P < 0.001) and further willingness to use CPAP (P < 0.01), although there were no significant differences in leak, AHI reduction, and optimal CPAP pressure between the two groups.
CONCLUSIONS: The use of HH is recommended during CPAP titration in the cool sleeping environment because of its benefit in the treatment of upper airway symptoms associated with CPAP therapy and improvement of the CPAP acceptance.