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01-02-2007 | Pediatric Original

Airway humidification with a heat and moisture exchanger in mechanically ventilated neonates

A preliminary evaluation

Authors: Mikaïla Fassassi, Fabrice Michel, Laurent Thomachot, Claire Nicaise, Renaud Vialet, Yves Jammes, Pierre Lagier, Claude Martin

Published in: Intensive Care Medicine | Issue 2/2007

Abstract

Objective

We set out to evaluate the efficacy of passive inspiratory gas conditioning in mechanically ventilated neonates and compared it with that of a heated humidifier (HH).

Design

Prospective, randomized, controlled study.

Setting

Neonatal and pediatric intensive care unit.

Patients

Fourteen mechanically ventilated neonates nursed in incubators.

Interventions

The HH was set to deliver a temperature of 37 °C and an absolute humidity of 40 mgH₂O/l at the incubator entrance. Inspired temperature (T°) and absolute humidity (AH) were measured by the psychometric method, transpulmonary pressure (Tpres) by means of a differential pressure transducer. Measurements were performed at 5, 10, and 15 min.

Measurements and results

The values of T° were significantly higher using the HH (34.6 ± 1.6 °C) than the heat and moisture exchanger (HME) (33.8 ± 2.3, p < 0.001). The values of AH were significantly higher using the HH (36.6 ± 2.5 mgH₂O/l) than the HME (32.4 ± 2.8 mgH₂O/l, p < 0.001). No significant changes were observed in transpulmonary pressure. A significant positive correlation was observed between incubator temperature and the temperature delivered by the HH (R² = 0.61, p < 0.001).

Conclusions

The use of HMEs in neonates made it possible to achieve an absolute humidity of 28 mgH₂O/l or more and a temperature of 30 °C or more. Higher values are obtained using a HH.

Chalon J, Loew D, Malebranche J (1972) Effect of dry anesthetic gases on tracheobronchial ciliated epithelium. Anesthesiology 37:338–343PubMedCrossRef

Marfatia S, Donahoe PK, Hendren WH (1975) Effect of dry and humidified gases on the respiratory epithelium in rabbits. J Paed Surg 10:583–587CrossRef

Forbes AR (1974) Temperature, humidity and mucus flow in the intubated trachea. Br J Anaesth 46:29–34PubMedCrossRef

Noguchi H, Takumi Y, Aochi O (1973) A study of humidification in tracheostomized dogs. Br J Anaesth 45:844–848PubMedCrossRef

Chalon J, Patel C, Ali M, Turndorf H, Fischgrund GK (1979) Humidity and the anesthetized patient. Anesthesiology 50:195–198PubMedCrossRef

Bethune D (1985) Hydrophobic versus hygroscopic heat and moisture exchangers [letter]. Anesthesia 40:210–211CrossRef

Sousulski R, Polin R, Baumgart S (1983) Respiratory water loss and heat balance in intubated infants receiving humidified air. J. Paediatrics 103:307–310CrossRef

Mebius CA (1989) Comparative evaluation of disposable humidifiers. Acta Anaesthesiol Scand 27:403–409CrossRef

Thomachot L, Leone M, Razzouk K, Antonini F, Vialet R, Martin C (2002) Randomized clinical trial of extended use of a hydrophobic condenser humidifier: 1 vs 7 days. Crit Care Med 30:232–237PubMedCrossRef

10.

O'Hagan M, E ER, Tarnow-Mordi W (1991) Is neonatal inspired gas humidity accurately controlled by humidifier temperature? Crit Care Med 19:1370–1373PubMedCrossRef

11.

Schulze A (2002) Respiratory gas conditioning in infants with an artificial airway. Semin Neonatol 7:369–377PubMedCrossRef

12.

Thomachot L, Boisson C, Arnaud S, Michelet P, Cambon S, Martin C (2000) Changing heat and moisture exchangers after 96 hours rather than after 24 hours: a clinical and microbiological evaluation. Crit Care Med 28:714–720PubMedCrossRef

13.

Thomachot L, Viviand X, Lagier P, Dejode JM, Albanèse J, Martin C (2001) Measurement of tracheal temperature is not a reliable index of total respiratory heat loss in mechanically ventilated patients. Crit Care 5:24–31PubMed

14.

Martin C, Thomachot L, Quinio B, Viviand X, Albanese J (1995) Comparing two heat and moisture exchangers with one vaporizing humidifier in patients with minute ventilation greater than 10 L/min. Chest 107:1411–1415PubMed

15.

Schiffmann H, Rathgeber J, Singer D, Harms K, Bolli A, Zuchner K (1997) Airway humidification in mechanically ventilated neonates and infants: a comparative study of a heat and moisture exchanger vs. a heated humidifier using a new fast-response capacitive humidity sensor. Crit Care Med 25:1755–1760PubMedCrossRef

16.

Richardson D, Corcoran J, Escobar G, Lee S (2001) SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 138:92–100PubMedCrossRef

17.

Condon E (1967) Handbook of physics. Churchill Livingstone, New York

18.

Milic-Emili J, Mead J, Turner J, Glauser E (1964) Improved technique for estimating pleural pressure from esophogeal balloons. J Appl Physiol 19:207–211PubMed

19.

Weeks DB (1986) A laboratory evaluation of recently available heat and moisture exchangers. Anesthesiol Rev 13:33–36

20.

Todd D, Boyd J, Lloyd J, John E (2001) Inspired gas humidity during mechanical ventilation: effects of humidification chamber, airway temperature, probe position and environmental conditions. J Paediatr Child Health 37:489–494PubMedCrossRef

21.

Luchetti M, Pigna A, Gentili A, Marraro G (1999) Evaluation of the efficiency of heat and moisture exchangers during paediatric anaesthesia. Paediatr Anaesth 9:39–45PubMedCrossRef

22.

Ryan S, Rankin N, Meyer E, Williams R (2002) Energy balance in the intubated human airway is an indicator of optimal gas conditioning. Crit Care Med 30:355–361PubMedCrossRef

23.

Williams R, Rankin N, Smith T, Galler D, Seakins P (1996) Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa. Crit Care Med 24:1920–1929PubMedCrossRef

24.

Lomholt N, Cooke R, Lunding M (1968) A method of humidification in ventilator treatment of neonates. Br J Anaesth 40:335–340PubMedCrossRef

25.

Nosovitch M, Johnson J, Tobias J (2002) Noninvasive intraoperative monitoring of carbon dioxide in children: endtidal versus transcutaneous techniques. Paediatr Anaesth 12:48–52PubMedCrossRef

26.

Dullenkopf A, Bernardo S, Berger F, Fasnacht M, Gerber A, Weiss M (2003) Evaluation of a new combined SpO2/PtcCO2 sensor in anaesthetized paediatric patients. Paediatr Anaesth 13:777–784PubMedCrossRef

27.

Lellouche F, Taillé S, Maggiore SM, Qader S, l'Her E, Deye N, Brochard L (2004) Influence of ambient and ventilator output temperatures on performance of heated-wire humidifiers. Am J Respir Crit Care Med 170:1073–1079PubMedCrossRef

28.

Carter BG, Whittington N, Hochmann M, Osborne A (2002) The effect of inlet gas temperature on heated humidifier performance. J Aeros Med 15:7–13CrossRef

29.

Davies MW, Dunster KR, Cartwright DW (2004) Inspired gas temperature in ventilated neonates. Ped Pulmol 38:50–54CrossRef

30.

Todd DA, Boyd J, Lloyd J, John E (2001) Inspired gas temperature during mechanical ventilation: effects of environmental temperature and airway temperature probe position. J Paediatr Child Health 37:495–500PubMedCrossRef

31.

Todd DA, Boyd J, Lloyd J, John E (2001) Inspired gas humidity during mechanical ventilation: effects of humidification chamber, airway temperature probe position and environmental conditions. J Paediatr Child Health 37:489–494PubMedCrossRef

32.

Schiffmann H, Singer S, Singer D, Richthofen EV, Rathgeber J, Züchner K (1999) Determination of airway humidification in high-frequency oscillatory ventilation using an artificial neonatal lung model. Comparison of a heated humidifier and a heat and moisture exchanger. Intensive Care Med 25:997–1002PubMedCrossRef

Title: Airway humidification with a heat and moisture exchanger in mechanically ventilated neonates
A preliminary evaluation
Authors: Mikaïla Fassassi
Fabrice Michel
Laurent Thomachot
Claire Nicaise
Renaud Vialet
Yves Jammes
Pierre Lagier
Claude Martin
Publication date: 01-02-2007
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 2/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-006-0466-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Airway humidification with a heat and moisture exchanger in mechanically ventilated neonates

A preliminary evaluation

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

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Defining duplicate publication: reply to H. F. Galley

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