Heat and Moisture Exchangers and Vaporizing Humidifiers in the Intensive Care Unit

Martin, Claude; Perrin, Gilles; Gevaudan, M. J.; Saux, P.; Gouin, F.

doi:10.1378/chest.97.1.144

Cited by 152 publications

(74 citation statements)

References 25 publications

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“…As heated humidifiers enhance the amount of condensate, attention has been focused on HMEs. These devices have led to a reduction in VAP, albeit small, and should be used in patients without significant secretions or concern over the risk of obstruction (17,55,99,107,132,141,174). While changing the HME less frequently than every 48 h may lead to further reductions in VAP, care must be taken to carefully monitor for trapped secretions and subsequent airway obstruction or increments in the work of breathing (45,193).…”

Section: Preventionmentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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SUMMARY While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algorithm for the bedside clinician and also focuses on the controversies with regard to diagnostic tools and approaches, treatment plans, and prevention strategies.

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Section: Preventionmentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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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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“…While one study reported a lower incidence of VAP associated with the use of HME [75], several studies found no significant differences between the two systems [74][75][76][77][78][79][80][81][82][83][84][85], and three studies found a lower incidence of VAP associated with HH [86][87][88].…”

Section: Heat and Moisture Exchangers Or Heated Humidifiersmentioning

confidence: 99%

“…A recent meta-analysis by KOLA et al [89], which enrolled 1,378 patients from nine trials [74][75][76][77][78][79][80][81][82], found that the use of HME decreased the VAP rate (relative risk 0.7, 95% CI 0.50-0.94). However, only one of the studies included in the meta-analysis by KOLA et al [89], the study by KIRTON et al [75], reported a significantly lower incidence of VAP with HME compared with HH.…”

Section: Heat and Moisture Exchangers Or Heated Humidifiersmentioning

confidence: 99%