Wednesday, December 7, 2011

No more mist tents

An old mist tent
About five years the infamous RT boss took all the mist tents and put them in the basement of the hospital because there was no room in the RT storage room.  This marked the end of the era of the mist tent for infants.

As a matter of fact, when oxygen was first introduced as a method of inhaling supplemental oxygen in the mid 19th century, the main technique was having the patient sit in a tent.  This was the main technique until the oxygen tank was invented.

During the 1920s oxygen masks and nasal cannulas became the best method of giving oxygen to adults, so tents were left to only a few adults but mainly kids.

Ultimately the tents were cooled by packing ice and water in the back of the device and a cool mist was added to the circulating air inside the tent.  This was one of the main methods of treating kids with inflamed upper air passages, or croup.

When I was 11 in 1981 my doctor wanted to put me in a tent once because I refused to wear a nasal cannula.  The RT was dilly-dallied for hours before complying with the order, yet eventually he talked me into sitting in it.  I remember watching TV through the blurry plastic.  After a few hours in was dinner time and I was allowed out.  I refused to get back in.

Yet even by 1981 using such tents on adults was rare as the grumbling RT implied.  By the time I became an RT in 1995 mist tents, or oxygen tents, were used for this purpose or simply to supply oxygen to kids.

It was to the point that doctors wouldn't even try allowing us to place a nasal cannula on a kid, it was just automatic a mist tent (or oxygen tent) be ordered.  It was our discretion whether we turned on the mist or left it off.  It was on for croup and off for asthma and RSV.  If the doctor had a preference he'd order either mist tent or oxygen tent.

Yet we RTs preferred to use a nasal cannula.  I have rarely met a kid who couldn't tolerate a nasal cannula.  Surely they might fight initially, yet once it's on they forget about it and tolerate it just fine.

The tents posed problems of their own.  For one thing, few kids wanted to stay in one.  Usually to get a kid to stay in the parent would cuddle in the tent-surrounded crib.  This made getting access to the kid difficult.  Plus toys were limited because some could spark and cause fires.

The reason I brought this up was because Advanced for RTs has reported that the CDC no longer recommends mist tents be used because they the mist enhances the spread of droplets in the air.  So this should mark the final farewell to the old and infamous mist tent.

Ironically the CDC has yet to outlaw nebulizers which equally spread droplets into rooms.  I'd like to see the CDC come out and recommend that one way valves or filters be used on all nebulizers, and, if possible, that nebulizers not be used at all unless indicated.

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3 comments:

Anonymous said...

The first practical oxygen tent was invented by Doctor Benjamin Eliasoph in 1921, at The Mount Sinai Hospital,New York, with rubberized fabric from the Goodyear Rubber Company, Aeronautical Division used for balloons such as the widely known Goodyear Blimp

Rick Frea said...

Hey, thank you, I did not know that. Will have to add this to my history of respiratory therapy over at hardluckasthma.blogspot.com

Knitted in the Womb said...

In 2004 my first son was diagnosed with croup. After sitting in the pediatricians office for about 3 hours, suddenly she decided that it was a dramatic emergency that my son need to be rushed to the hospital for further treatment. He oxygen saturation in the pediatrician's office had never gone below 97%. I didn't know what a "good" range was...but I knew that I was tired, cranky, and hungry, my newborn was tired, cranky, and hungry, and my 2 year old with croup was definitely tired, cranky, and hungry. It was about 7 p.m. I told the pediatrician I was going home to get a change of clothes for everyone and some dinner, THEN I would go to the hospital. She was quite annoyed with me. I did it anyway.

I got to the hospital where an oxygen tent was set up for my son. After a lot of coaxing, he went into it, but was not happy. I managed to get him to fall asleep despite the loud noise he was making.

But then he woke up about and hour later and wanted out, and no amount of coaxing could get him back in. I even tried laying under the tent with him...at which point all hope of getting him to stay under there was lost, because I discovered it was MUCH louder under the tent than sitting right beside it.

I'm an employee safety specialist. Even without a noise meter I could tell you that if I allowed an employee to work in an environment with such loud noise levels without requiring hearing protection, OSHA would have a field day.

Just a few minutes ago on "drugs.com" I saw a comment about care providers taping gauze over a baby's ears to provide hearing protection while using an oxygen tent. REALLY? GAUZE? That will do VERY little to reduce the noise reaching the baby's ears, unless enough gauze to make the kid look like Mickey Mouse is used.

Not only can noise exposure cause hearing loss in the long run, it can cause stress and elevated blood pressure in the short run, which certainly is not a good thing for a sick child. I find it amazing that the effects of noise exposure in medical treatment of children (think numerous loud alarms in NICUs) is not really considered.