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Regiroli G, Loi B, Fortas F, Centorrino R, Mosca F, De Luca D. Effect of inspired gas temperature on lung mechanics and gas exchange in neonates in normothermia or therapeutic hypothermia. Resuscitation 2021; 163:116-123. [PMID: 33895234 DOI: 10.1016/j.resuscitation.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/27/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Respiratory critical care guidelines suggest heating the air/oxygen mixture but do not recommend a specific temperature target. We aimed to clarify if the inspired gas temperature influences lung mechanics and gas exchange in intubated patients treated with whole body hypothermia (WBH) or normothermia (NT). METHODS Prospective cohort study enrolling neonates ventilated for perinatal asphyxia resuscitation (no lung disease) or acute hypoxemic respiratory failure. Patients were divided between those ventilated in NT or WBH. Compliance (Cdyn), airway resistances (Raw), oxygenation index (OI), PaO2/FiO2, A-a gradient, a/A ratio, estimated alveolar dead space (VDalv), ventilatory index (VI) and CO2 production (VCO2) were registered at the study beginning (inspired gas at 37°C). Then, gas temperature was decreased (32 °C) and variables were recorded again after 1 and 3 h. Data were analysed with univariate and multivariate repeated measures-ANOVA. RESULTS Cdyn, Raw, OI, PaO2/FiO2, A-a gradient, a/A ratio, VDalv, VI and VCO2 are similar between WBH and NT at any timepoint (between-subjects effect); these results do not change adjusting for the presence of respiratory failure. When this is considered in multivariate ANOVA (within-subjects effect), Cdyn (p = 0.016), Raw (p = 0.034) and VDalv (p < 0.001) were worse in patients with respiratory failure than in those without lung disease. CONCLUSIONS Decreasing the gas temperature from 37 °C to 32 °C for 3 h does not change lung mechanics and gas exchange, neither in neonates with, nor in those without respiratory failure and in those treated in NT or WBH. These findings fill a knowledge gap regarding the effect of inspired gas temperature during WBH: they may inform future respiratory critical care guidelines.
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Affiliation(s)
- Giulia Regiroli
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France; Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France
| | - Feriel Fortas
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Roberta Centorrino
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.
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Adult post-cardiac arrest interventions: An overview of randomized clinical trials. Resuscitation 2020; 147:1-11. [DOI: 10.1016/j.resuscitation.2019.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 02/02/2023]
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Plotnikow GA, Accoce M, Navarro E, Tiribelli N. Humidification and heating of inhaled gas in patients with artificial airway. A narrative review. Rev Bras Ter Intensiva 2018; 30:86-97. [PMID: 29742220 PMCID: PMC5885236 DOI: 10.5935/0103-507x.20180015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/30/2017] [Indexed: 01/15/2023] Open
Abstract
Instrumentation of the airways in critical patients (endotracheal tube or
tracheostomy cannula) prevents them from performing their function of humidify
and heating the inhaled gas. In addition, the administration of cold and dry
medical gases and the high flows that patients experience during invasive and
non-invasive mechanical ventilation generate an even worse condition. For this
reason, a device for gas conditioning is needed, even in short-term treatments,
to avoid potential damage to the structure and function of the respiratory
epithelium. In the field of intensive therapy, the use of heat and moisture
exchangers is common for this purpose, as is the use of active humidification
systems. Acquiring knowledge about technical specifications and the advantages
and disadvantages of each device is needed for proper use since the conditioning
of inspired gases is a key intervention in patients with artificial airway and
has become routine care. Incorrect selection or inappropriate configuration of a
device can have a negative impact on clinical outcomes. The members of the
Capítulo de Kinesiología Intensivista of the
Sociedad Argentina de Terapia Intensiva conducted a
narrative review aiming to show the available evidence regarding conditioning of
inhaled gas in patients with artificial airways, going into detail on concepts
related to the working principles of each one.
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Affiliation(s)
- Gustavo Adrián Plotnikow
- Capítulo de Kinesiología Intensivista, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | - Matias Accoce
- Capítulo de Kinesiología Intensivista, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | - Emiliano Navarro
- Capítulo de Kinesiología Intensivista, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | - Norberto Tiribelli
- Capítulo de Kinesiología Intensivista, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
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Gillies D, Todd DA, Foster JP, Batuwitage BT. Heat and moisture exchangers versus heated humidifiers for mechanically ventilated adults and children. Cochrane Database Syst Rev 2017; 9:CD004711. [PMID: 28905374 PMCID: PMC6483749 DOI: 10.1002/14651858.cd004711.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Invasive ventilation is used to assist or replace breathing when a person is unable to breathe adequately on their own. Because the upper airway is bypassed during mechanical ventilation, the respiratory system is no longer able to warm and moisten inhaled gases, potentially causing additional breathing problems in people who already require assisted breathing. To prevent these problems, gases are artificially warmed and humidified. There are two main forms of humidification, heat and moisture exchangers (HME) or heated humidifiers (HH). Both are associated with potential benefits and advantages but it is unclear whether HME or HH are more effective in preventing some of the negative outcomes associated with mechanical ventilation. This review was originally published in 2010 and updated in 2017. OBJECTIVES To assess whether heat and moisture exchangers or heated humidifiers are more effective in preventing complications in people receiving invasive mechanical ventilation and to identify whether the age group of participants, length of humidification, type of HME, and ventilation delivered through a tracheostomy had an effect on these findings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and CINAHL up to May 2017 to identify randomized controlled trials (RCTs) and reference lists of included studies and relevant reviews. There were no language limitations. SELECTION CRITERIA We included RCTs comparing HMEs to HHs in adults and children receiving invasive ventilation. We included randomized cross-over studies. DATA COLLECTION AND ANALYSIS We assessed the quality of each study and extracted the relevant data. Where possible, we analysed data through meta-analysis. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (95% CI). For continuous outcomes, we calculated the mean difference (MD) and 95% CI or standardized mean difference (SMD) and 95% CI for parallel studies. For cross-over trials, we calculated the MD and 95% CI using correlation estimates to correct for paired analyses. We aimed to conduct subgroup analyses based on the age group of participants, how long they received humidification, type of HME and whether ventilation was delivered through a tracheostomy. We also conducted sensitivity analysis to identify whether the quality of trials had an effect on meta-analytic findings. MAIN RESULTS We included 34 trials with 2848 participants; 26 studies were parallel-group design (2725 participants) and eight used a cross-over design (123 participants). Only three included studies reported data for infants or children. Two further studies (76 participants) are awaiting classification.There was no overall statistical difference in artificial airway occlusion (RR 1.59, 95% CI 0.60 to 4.19; participants = 2171; studies = 15; I2 = 54%), mortality (RR 1.03, 95% CI 0.89 to 1.20; participants = 1951; studies = 12; I2 = 0%) or pneumonia (RR 0.93, 95% CI 0.73 to 1.19; participants = 2251; studies = 13; I2 = 27%). There was some evidence that hydrophobic HMEs may reduce the risk of pneumonia compared to HHs (RR 0.48, 95% CI 0.28 to 0.82; participants = 469; studies = 3; I2 = 0%)..The overall GRADE quality of evidence was low. Although the overall methodological risk of bias was generally unclear for selection and detection bias and low risk for follow-up, the selection of study participants who were considered suitable for HME and in some studies removing participants from the HME group made the findings of this review difficult to generalize. AUTHORS' CONCLUSIONS The available evidence suggests no difference between HMEs and HHs on the primary outcomes of airway blockages, pneumonia and mortality. However, the overall low quality of this evidence makes it difficult to be confident about these findings. Further research is needed to compare HMEs to HHs, particularly in paediatric and neonatal populations, but research is also needed to more effectively compare different types of HME to each other as well as different types of HH.
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Affiliation(s)
| | - David A Todd
- The Canberra HospitalNeonatal UnitCentre for Newborn CarePO Box 11, WodenCanberraACTAustralia2606
| | - Jann P Foster
- Western Sydney UniversitySchool of Nursing and MidwiferyPenrith DCAustralia
| | - Bisanth T Batuwitage
- Queen Alexandra Hospital, Portsmouth Hospitals NHS TrustDepartment of AnaesthesiaSouthwick Hill RoadPortsmouthUKPO6 3LY
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Vargas M, Chiumello D, Sutherasan Y, Ball L, Esquinas AM, Pelosi P, Servillo G. Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) in adult critically ill patients: a systematic review, meta-analysis and meta-regression of randomized controlled trials. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:123. [PMID: 28552074 PMCID: PMC5447307 DOI: 10.1186/s13054-017-1710-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 05/09/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aims of this systematic review and meta-analysis of randomized controlled trials are to evaluate the effects of active heated humidifiers (HHs) and moisture exchangers (HMEs) in preventing artificial airway occlusion and pneumonia, and on mortality in adult critically ill patients. In addition, we planned to perform a meta-regression analysis to evaluate the relationship between the incidence of artificial airway occlusion, pneumonia and mortality and clinical features of adult critically ill patients. METHODS Computerized databases were searched for randomized controlled trials (RCTs) comparing HHs and HMEs and reporting artificial airway occlusion, pneumonia and mortality as predefined outcomes. Relative risk (RR), 95% confidence interval for each outcome and I 2 were estimated for each outcome. Furthermore, weighted random-effect meta-regression analysis was performed to test the relationship between the effect size on each considered outcome and covariates. RESULTS Eighteen RCTs and 2442 adult critically ill patients were included in the analysis. The incidence of artificial airway occlusion (RR = 1.853; 95% CI 0.792-4.338), pneumonia (RR = 932; 95% CI 0.730-1.190) and mortality (RR = 1.023; 95% CI 0.878-1.192) were not different in patients treated with HMEs and HHs. However, in the subgroup analyses the incidence of airway occlusion was higher in HMEs compared with HHs with non-heated wire (RR = 3.776; 95% CI 1.560-9.143). According to the meta-regression, the effect size in the treatment group on artificial airway occlusion was influenced by the percentage of patients with pneumonia (β = -0.058; p = 0.027; favors HMEs in studies with high prevalence of pneumonia), and a trend was observed for an effect of the duration of mechanical ventilation (MV) (β = -0.108; p = 0.054; favors HMEs in studies with longer MV time). CONCLUSIONS In this meta-analysis we found no superiority of HMEs and HHs, in terms of artificial airway occlusion, pneumonia and mortality. A trend favoring HMEs was observed in studies including a high percentage of patients with pneumonia diagnosis at admission and those with prolonged MV. However, the choice of humidifiers should be made according to the clinical context, trying to avoid possible complications and reaching the appropriate performance at lower costs.
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Affiliation(s)
- Maria Vargas
- Department of Neurosciences, Reproductive and Odonthostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - Davide Chiumello
- Dipartimento di Emergenza - Urgenza, ASST Santi Paolo e Carlo; Dipartimento di Scienze della salute, Università degli Studi di Milano, Milan, Italy
| | - Yuda Sutherasan
- Division of pulmonary and critical care medicine, Faculty of medicine Ramathibodi hospital, Mahidol University, 270 RAMA VI road, Bangkok, 10400, Thailand
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics, AOU IRCCS San Martino- IST, University of Genoa, Genoa, Italy
| | | | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, AOU IRCCS San Martino- IST, University of Genoa, Genoa, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odonthostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Insufficient Humidification of Respiratory Gases in Patients Who Are Undergoing Therapeutic Hypothermia at a Paediatric and Adult Intensive Care Unit. Can Respir J 2017; 2017:8349874. [PMID: 28512388 PMCID: PMC5415665 DOI: 10.1155/2017/8349874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/02/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022] Open
Abstract
For cooled newborn infants, humidifier settings for normothermic condition provide excessive gas humidity because absolute humidity at saturation is temperature-dependent. To assess humidification of respiratory gases in patients who underwent moderate therapeutic hypothermia at a paediatric/adult intensive care unit, 6 patients were studied over 9 times. Three humidifier settings, 37-default (chamber-outlet, 37°C; Y-piece, 40°C), 33.5-theoretical (chamber-outlet, 33.5°C; Y-piece, 36.5°C), and 33.5-adjusted (optimised setting to achieve saturated vapour at 33.5°C using feedback from a thermohygrometer), were tested. Y-piece gas temperature/humidity and the incidence of high (>40.6 mg/L) and low (<32.9 mg/L) humidity relative to the target level (36.6 mg/L) were assessed. Y-piece gas humidity was 32.0 (26.8–37.3), 22.7 (16.9–28.6), and 36.9 (35.5–38.3) mg/L {mean (95% confidence interval)} for 37-default setting, 33.5-theoretical setting, and 33.5-adjusted setting, respectively. High humidity was observed in 1 patient with 37-default setting, whereas low humidity was seen in 5 patients with 37-default setting and 8 patients with 33.5-theoretical setting. With 33.5-adjusted setting, inadequate Y-piece humidity was not observed. Potential risks of the default humidifier setting for insufficient respiratory gas humidification were highlighted in patients cooled at a paediatric/adult intensive care unit. Y-piece gas conditions can be controlled to the theoretically optimal level by adjusting the setting guided by Y-piece gas temperature/humidity.
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Tanaka S, Iwata S, Kinoshita M, Tsuda K, Sakai S, Saikusa M, Shindo R, Harada E, Okada J, Hisano T, Kanda H, Maeno Y, Araki Y, Ushijima K, Sakamoto T, Yamashita Y, Iwata O. Use of Normothermic Default Humidifier Settings Causes Excessive Humidification of Respiratory Gases During Therapeutic Hypothermia. Ther Hypothermia Temp Manag 2016; 6:180-188. [PMID: 27167667 DOI: 10.1089/ther.2016.0005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adult patients frequently suffer from serious respiratory complications during therapeutic hypothermia. During therapeutic hypothermia, respiratory gases are humidified close to saturated vapor at 37°C (44 mg/L) despite that saturated vapor reduces considerably depending on temperature reduction. Condensation may cause serious adverse events, such as bronchial edema, mucosal dysfunction, and ventilator-associated pneumonia during cooling. To determine clinical variables associated with inadequate humidification of respiratory gases during cooling, humidity of inspiratory gases was measured in 42 cumulative newborn infants who underwent therapeutic hypothermia. Three humidifier settings of 37-default (chamber outlet, 37°C; distal circuit, 40°C), 33.5-theoretical (chamber outlet, 33.5°C; distal circuit, 36.5°C), and 33.5-adjusted (optimized setting to achieve 36.6 mg/L using feedback from a hygrometer) were tested to identify independent variables of excessively high humidity >40.7 mg/L and low humidity <32.9 mg/L. The mean (SD) humidity at the Y-piece was 39.2 (5.2), 33.3 (4.1), and 36.7 (1.2) mg/L for 37-default, 33.5-theoretical, and 33.5-adjusted, respectively. The incidence of excessive high humidity was 10.3% (37-default, 31.0%; 33.5-theoretical, 0.0%; 33.5-adjusted, 0.0%), which was positively associated with the use of a counter-flow humidifier (p < 0.001), 37-default (compared with 33.5-theoretical and 33.5-adjusted, both p < 0.001) and higher fraction of inspired oxygen (p = 0.003). The incidence of excessively low humidity was 17.5% (37-default, 7.1%; 33.5-theoretical, 45.2%; 33.5-adjusted, 0.0%), which was positively associated with the use of a pass-over humidifier and 33.5-theoretical (both p < 0.001). All patients who used a counter-flow humidifier achieved the target gas humidity at the Y-piece (36.6 ± 0.5 mg/L) required for 33.5-adjusted with 33.5-theoretical. During cooling, 37-default is associated with excessively high humidity, whereas 33.5-theoretical leads to excessively low humidity. Future studies are needed to assess whether a new regimen with optimized Y-piece temperature and humidity control reduces serious respiratory adverse events during cooling.
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Affiliation(s)
- Shoichiro Tanaka
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
| | - Sachiko Iwata
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
| | - Masahiro Kinoshita
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
| | - Kennosuke Tsuda
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
| | - Sayaka Sakai
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
| | - Mamoru Saikusa
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
| | - Ryota Shindo
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
| | - Eimei Harada
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
| | - Junichiro Okada
- 2 Division of Neonatology, St. Mary's Hospital , Fukuoka, Japan
| | - Tadashi Hisano
- 2 Division of Neonatology, St. Mary's Hospital , Fukuoka, Japan
| | - Hiroshi Kanda
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
| | - Yasuki Maeno
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
| | - Yuko Araki
- 3 Department of Informatics, Graduate School of Integrated Science and Technology, Shizuoka University , Shizuoka, Japan
| | - Kazuo Ushijima
- 4 Department of Anaesthesiology, Kurume University School of Medicine , Fukuoka, Japan
| | - Teruo Sakamoto
- 5 Advanced Emergency Medical Service Centre, Kurume University Hospital , Fukuoka, Japan
| | - Yushiro Yamashita
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
| | - Osuke Iwata
- 1 Department of Pediatrics and Child Health, Centre for Developmental and Cognitive Neuroscience, Kurume University School of Medicine , Fukuoka, Japan
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Lellouche F. Quelle technique d’humidification pour la ventilation invasive et non invasive ? MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1131-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Humidification during mechanical ventilation in the adult patient. BIOMED RESEARCH INTERNATIONAL 2014; 2014:715434. [PMID: 25089275 PMCID: PMC4096064 DOI: 10.1155/2014/715434] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/19/2014] [Accepted: 05/27/2014] [Indexed: 12/17/2022]
Abstract
Humidification of inhaled gases has been standard of care in mechanical ventilation for a long period of time. More than a century ago, a variety of reports described important airway damage by applying dry gases during artificial ventilation. Consequently, respiratory care providers have been utilizing external humidifiers to compensate for the lack of natural humidification mechanisms when the upper airway is bypassed. Particularly, active and passive humidification devices have rapidly evolved. Sophisticated systems composed of reservoirs, wires, heating devices, and other elements have become part of our usual armamentarium in the intensive care unit. Therefore, basic knowledge of the mechanisms of action of each of these devices, as well as their advantages and disadvantages, becomes a necessity for the respiratory care and intensive care practitioner. In this paper, we review current methods of airway humidification during invasive mechanical ventilation of adult patients. We describe a variety of devices and describe the eventual applications according to specific clinical conditions.
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Effect of Active Airway Warming on Body Core Temperature During Adult Liver Transplantation. Transplant Proc 2013; 45:251-4. [DOI: 10.1016/j.transproceed.2012.05.088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 05/16/2012] [Indexed: 11/23/2022]
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Morán I, Cabello B, Manero E, Mancebo J. Comparison of the effects of two humidifier systems on endotracheal tube resistance. Intensive Care Med 2011; 37:1773-9. [PMID: 21946924 DOI: 10.1007/s00134-011-2351-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 09/01/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the effects of two humidifier systems on endotracheal tube (ETT) resistance during mechanical ventilation, either an active heated humidifier (HH) or a passive heat and moisture exchanger (HME) was selected using current clinical recommendations. METHODS This was a prospective clinical cohort study performed in an intensive care unit. Gas conditioning was performed using the HH in 22 patients and the HME in another 22. Patients were matched for endotracheal tube diameter, days of mechanical ventilation, simplified acute physiology score II (SAPS II), and fluid balance. RESULTS Used-ETT resistance was measured immediately after extubation. Unused-ETT resistance was calculated with an identical, clean ETT. No differences were found between the HH and HME groups in ETT diameter (7.9 ± 0.4 vs. 7.9 ± 0.3 mm; p = 0.98), days of mechanical ventilation (11.3 ± 7.7 vs. 9.5 ± 4.5; p = 0.34), SAPS II (41.0 ± 13.6 vs. 42.0 ± 11.7; p = 0.79), or fluid balance (-2,552 ± 6,268 vs. -2,579 ± 5,422 mL; p = 0.98). ETT resistance increased from intubation to extubation: from 6.8 ± 1.1 to 10.6 ± 4.3 cmH(2)O L(-1) s(-1) in the HH group, (p < 0.001) and from 6.8 ± 1.1 to 10.2 ± 3.8 cmH(2)O L(-1) s(-1) in the HME group (p < 0.001), which is a 53% average increase in resistive load. CONCLUSIONS We did not find differences between the two types of humidifiers in terms of airflow resistance during prolonged mechanical ventilation when the devices were selected on the basis of individual clinical needs. The increase in resistive load is physiologically relevant.
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Affiliation(s)
- Indalecio Morán
- Servei Medicina Intensiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
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Kelly M, Gillies D, Todd DA, Lockwood C. Heated humidification versus heat and moisture exchangers for ventilated adults and children. Cochrane Database Syst Rev 2010:CD004711. [PMID: 20393939 DOI: 10.1002/14651858.cd004711.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Humidification by artificial means must be provided when the upper airway is bypassed during mechanical ventilation. Heated humidification (HH) and heat and moisture exchangers (HME) are the most commonly used types of artificial humidification in this situation. OBJECTIVES To determine whether HHs or HMEs are more effective in preventing mortality and other complications in people who are mechanically ventilated. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 4) and MEDLINE, EMBASE and CINAHL (January, 2010) to identify relevant randomized controlled trials (RCTs). SELECTION CRITERIA We included RCTs comparing heat and moisture exchangers (HMEs) to heated humidifiers (HHs) in mechanically ventilated adults and children. We included randomized crossover studies. DATA COLLECTION AND ANALYSIS We assessed the quality of each study and extracted the relevant data. Where appropriate, results from relevant studies were meta-analysed for individual outcomes. MAIN RESULTS We included 33 trials with 2833 participants, 25 studies were parallel group design (n = 2710) and eight crossover design (n = 123). Only three included studies reported data for infants or children. There was no overall effect on artificial airway occlusion, mortality, pneumonia, or respiratory complications; however, the PaCO(2) and minute ventilation were increased when HMEs were compared to HHs and body temperature was lower. The cost of HMEs was lower in all studies that reported this outcome. There was some evidence that hydrophobic HMEs may reduce the risk of pneumonia and that blockages of artificial airways may be increased with the use of HMEs in certain subgroups of patients. AUTHORS' CONCLUSIONS There is little evidence of an overall difference between HMEs and HHs. However, hydrophobic HMEs may reduce the risk of pneumonia and the use of an HME may increase artificial airway occlusion in certain subgroups of patients. Therefore, HMEs may not be suitable for patients with limited respiratory reserve or prone to airway blockage. Further research is needed relating to hydrophobic versus hygroscopic HMEs and the use of HMEs in the paediatric and neonatal populations. As the design of HMEs evolves, evaluation of new generation HMEs will also need to be undertaken.
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Affiliation(s)
- Margaret Kelly
- Nursing Research & Practice Development Unit, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia, 2145
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Lellouche F, Taillé S, Lefrançois F, Deye N, Maggiore SM, Jouvet P, Ricard JD, Fumagalli B, Brochard L. Humidification performance of 48 passive airway humidifiers: comparison with manufacturer data. Chest 2009; 135:276-286. [PMID: 19201708 DOI: 10.1378/chest.08-0679] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Heat and moisture exchangers (HMEs) are increasingly used in the ICU for gas conditioning during mechanical ventilation. Independent assessments of the humidification performance of HMEs are scarce. The aim of the present study was thus to assess the humidification performance of a large number of adult HMEs. METHOD We assessed 48 devices using a bench test apparatus that simulated real-life physiologic ventilation conditions. Thirty-two devices were described by the manufacturers as HMEs, and 16 were described as antibacterial filters. The test apparatus provided expiratory gases with an absolute humidity (AH) of 35 mg H(2)O/L. The AH of inspired gases was measured after steady state using the psychrometric method. We performed three hygrometric measurements for each device, measured their resistance, and compared our results with the manufacturer data. RESULTS Of the 32 HMEs tested, only 37.5% performed well (>or= 30 mg H(2)O/L), while 25% performed poorly (< 25 mg H(2)O/L). The mean difference (+/- SD) between our measurements and the manufacturer data was 3.0 +/- 2.7 mg H(2)O/L for devices described as HMEs (maximum, 8.9 mg H(2)O/L) [p = 0.0001], while the mean difference for 36% of the HMEs was > 4 mg H(2)O/L. The mean difference for the antibacterial filters was 0.2 +/- 1.4 mg H(2)O/L. The mean resistance of all the tested devices was 2.17 +/- 0.70 cm H(2)O/L/s. CONCLUSIONS Several HMEs performed poorly and should not be used as HMEs. The values determined by independent assessments may be lower than the manufacturer data. Describing a device as an HME does not guarantee that it provides adequate humidification. The performance of HMEs must be verified by independent assessment.
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Affiliation(s)
- François Lellouche
- Service de Soins Intensifs de Chirurgie Cardiaque, Centre de Recherche Hôpital Laval, Université Laval, Québec City, QC, Canada.
| | - Solenne Taillé
- Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Albert Chenevier-Henri-Mondor, Créteil, France
| | - Frédéric Lefrançois
- Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Albert Chenevier-Henri-Mondor, Créteil, France
| | - Nicolas Deye
- Service de Réanimation Médicale, Hôpital Lariboisière, Paris, France
| | | | - Philippe Jouvet
- Service de Réanimation Médicale Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Jean-Damien Ricard
- Service de Réanimation Médicale, Hôpital Louis Mourier, Hôpitaux de Paris, Colombes, Paris, France
| | - Bruno Fumagalli
- Pharmacie Centrale des Hôpitaux-Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Brochard
- Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Albert Chenevier-Henri-Mondor, Créteil, France
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Gold standard for humidification: Heat and moisture exchangers, heated humidifiers, or both?*. Crit Care Med 2007. [DOI: 10.1097/00003246-200712000-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gold standard for humidification: Heat and moisture exchangers, heated humidifiers, or both?*. Crit Care Med 2007; 35:2875-6. [DOI: 10.1097/01.ccm.0000295268.55029.ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, De Backer D, Dobb G, Fagon JY, Gerlach H, Groeneveld J, Macrae D, Mancebo J, Metnitz P, Nava S, Pugin J, Pinsky M, Radermacher P, Richard C. Year in review in Intensive Care Medicine, 2006. II. Infections and sepsis, haemodynamics, elderly, invasive and noninvasive mechanical ventilation, weaning, ARDS. Intensive Care Med 2007; 33:214-29. [PMID: 17221187 PMCID: PMC7079976 DOI: 10.1007/s00134-006-0512-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 12/18/2006] [Indexed: 01/04/2023]
Affiliation(s)
- Peter Andrews
- Intensive Care Medicine Unit, Western General Hospital, Edinburgh, UK
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