A change in humidification system can eliminate endotracheal tube occlusion

Doyle, Alex; Joshi, Manasi; Frank, Peter; Craven, Thomas; Moondi, Parvez; Young, Peter

doi:10.1016/j.jcrc.2011.02.004

Cited by 19 publications

(11 citation statements)

References 16 publications

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“…25 In mechanically ventilated patients, when an endotracheal or tracheostomy tube bypasses the upper airway, where most humidification would naturally occur, poor humidification increases in the incidence of endotracheal tube occlusion. 26 As little as 5 min of delivery of ambient gas directly at the trachea can cause a significant decrease in pulmonary compliance and conductance in infants. 27 By contrast, conditioning of the gas minimizes airway constriction, reduces the work of breathing (WOB), improves mucociliary function, 5 facilitates clearance of secretions, and is associated with less atelectasis, resulting in a good ventilation/perfusion ratio and better oxygenation.…”

Section: Adverse Effects Of Lack Of Humidificationmentioning

confidence: 99%

High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects

2016

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High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. Able to deliver adequately heated and humidified medical gas at flows up to 60 L/min, it is considered to have a number of physiological advantages compared with other standard oxygen therapies, including reduced anatomical dead space, PEEP, constant F IO 2 , and good humidification. Although few large randomized clinical trials have been performed, HFNC has been gaining attention as an alternative respiratory support for critically ill patients. Published data are mostly available for neonates. For critically ill adults, however, evidence is uneven because the reports cover various subjects with diverse underlying conditions, such as hypoxemic respiratory failure, exacerbation of COPD, postextubation, preintubation oxygenation, sleep apnea, acute heart failure, and conditions entailing do-not-intubate orders. Even so, across the diversity, many published reports suggest that HFNC decreases breathing frequency and work of breathing and reduces the need for respiratory support escalation. Some important issues remain to be resolved, such as definitive indications for HFNC and criteria for timing the starting and stopping of HFNC and for escalating treatment. Despite these issues, HFNC has emerged as an innovative and effective modality for early treatment of adults with respiratory failure with diverse underlying diseases.

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Section: Adverse Effects Of Lack Of Humidificationmentioning

confidence: 99%

High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects

2016

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“…The effects of inadequate humidification are known to increase with duration, 10 which may explain the differences in clinical events between the 20-hour and 10-week studies. It has been reported that in adults mechanically ventilated in the ICU there are fewer endotracheal tube occlusions with HH than with HME, [11][12][13][14][15] despite the fact that subjects with "thick" airway secretions were excluded from all trials. 16 In tracheostomized adult patients there has been one published long-term study of humidification, which compared HME to no treatment and found a decrease in the occurrence of pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Heated Humidification Improves Clinical Outcomes, Compared to a Heat and Moisture Exchanger in Children With Tracheostomies

et al. 2013

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BACKGROUND:The upper airway humidifies and warms inspired gases before they reach the trachea, a process bypassed by the insertion of a tracheostomy, necessitating humidification of inspired gases. The optimal method of humidification is not known. METHODS: We conducted a short-term 20-hour study and a long-term 10-week randomized crossover study comparing a heated humidifier (HH) to a heat and moisture exchanger (HME) in children with established tracheostomies. Subjects were assessed for clinical events, clinical examination findings, airway cytokine levels, and airway secretion viscoelasticity. RESULTS: For the short-term study, 15 children were recruited; for the long-term study, 14 children were recruited. Children using the HH had decreased respiratory examination score (P < .001) but no change in clinical events over the short term. There was a decrease in acute clinical events (P ‫؍‬ .008) in the long-term study. No differences were found in airway secretion viscoelasticity results or cytokine levels in either study, but these sample numbers were limited. CONCLUSIONS: Over 20 hours use, HH, compared to HME, improved work of breathing. Over a longer 10 week treatment period HH resulted in decreased adverse clinical events.

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“…The most severe complication is endotracheal tube obstruction by secretion. This is due to diminished moisture production, especially when a larger minute volume is employed, which is common to all commercially available instruments to a higher or lesser extent ( 17 , 20 ). In our case, obstruction of the endotracheal tube with need for re-intubation did not occur, but this is an adverse effect that has been described in other studies ( 21 - 28 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients

Auxiliadora‐Martins

Menegueti

Nicolini

et al. 2012

Braz J Med Biol Res

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Ventilator-associated pneumonia (VAP) remains one of the major causes of infection in the intensive care unit (ICU) and is associated with the length of hospital stay, duration of mechanical ventilation, and use of broad-spectrum antibiotics. We compared the frequency of VAP 10 months prior to (pre-intervention group) and 13 months after (post-intervention group) initiation of the use of a heat and moisture exchanger (HME) filter. This is a study with prospective before-and-after design performed in the ICU in a tertiary university hospital. Three hundred and fourteen patients were admitted to the ICU under mechanical ventilation, 168 of whom were included in group HH (heated humidifier) and 146 in group HME. The frequency of VAP per 1000 ventilator-days was similar for both the HH and HME groups (18.7 vs 17.4, respectively; P = 0.97). Duration of mechanical ventilation (11 vs 12 days, respectively; P = 0.48) and length of ICU stay (11 vs 12 days, respectively; P = 0.39) did not differ between the HH and HME groups. The chance of developing VAP was higher in patients with a longer ICU stay and longer duration of mechanical ventilation. This finding was similar when adjusted for the use of HME. The use of HME in intensive care did not reduce the incidence of VAP, the duration of mechanical ventilation, or the length of stay in the ICU in the study population.

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A change in humidification system can eliminate endotracheal tube occlusion

Cited by 19 publications

References 16 publications

High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects

High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects

Heated Humidification Improves Clinical Outcomes, Compared to a Heat and Moisture Exchanger in Children With Tracheostomies

Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients

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