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Intensive Care Medicine
Published in: Intensive Care Medicine 4/2006

01-04-2006 | Original

Heat and moisture exchangers and heated humidifiers in acute lung injury/acute respiratory distress syndrome patients. Effects on respiratory mechanics and gas exchange

Authors: Indalecio Morán, Judith Bellapart, Alessandra Vari, Jordi Mancebo

Published in: Intensive Care Medicine | Issue 4/2006

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Abstract

Objective

To compare, in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) patients, the short-term effects of heat and moisture exchangers (HME) and heated humidifiers (HH) on gas exchange, and also on respiratory system mechanics when isocapnic conditions are met.

Design

Prospective open clinical study.

Setting

Intensive Care Service.

Patients

Seventeen invasively ventilated ALI/ARDS patients.

Intervention

The study was performed in three phases: (1) determinations were made during basal ventilatory settings with HME; (2) basal ventilatory settings were maintained and HME was replaced by an HH; (3) using the same HH, tidal volume (Vt) was decreased until basal PaCO2 levels were reached. FiO2, respiratory rate and PEEP were kept unchanged.

Measurements and results

Respiratory mechanics, Vdphys, gas exchange and hemodynamic parameters were obtained at each phase. By using HH instead of HME and without changing Vt, PaCO2 decreased from 46 ± 9 to 40 ± 8 mmHg (p < 0.001) and Vdphys decreased from 352 ± 63 to 310 ± 74 ml (p < 0.001). Comparing the first phase with the third, Vt decreased from 521 ± 106 to 440 ± 118 ml (p < 0.001) without significant changes in PaCO2, Vd/Vt decreased from 0.69 ± 0.11 to 0.62 ± 0.12 (p < 0.001), plateau airway pressure decreased from 25 ± 6 to 21 ± 6 cmH2O (p < 0.001) and respiratory system compliance improved from 35 ± 12 to 42 ± 15 ml/cmH2O (p < 0.001). PaO2 remained unchanged in the three phases.

Conclusions

Reducing dead space with the use of HH decreases PaCO2 and more importantly, if isocapnic conditions are maintained by reducing Vt, this strategy improves respiratory system compliance and reduces plateau airway pressure
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Metadata
Title
Heat and moisture exchangers and heated humidifiers in acute lung injury/acute respiratory distress syndrome patients. Effects on respiratory mechanics and gas exchange
Authors
Indalecio Morán
Judith Bellapart
Alessandra Vari
Jordi Mancebo
Publication date
01-04-2006
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 4/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-006-0073-1

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