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Intensive Care Medicine
Published in: Intensive Care Medicine 11/2011

01-11-2011 | Original

Comparison of the effects of two humidifier systems on endotracheal tube resistance

Authors: Indalecio Morán, Belén Cabello, Elizabeth Manero, Jordi Mancebo

Published in: Intensive Care Medicine | Issue 11/2011

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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 cmH2O L−1 s−1 in the HH group, (p < 0.001) and from 6.8 ± 1.1 to 10.2 ± 3.8 cmH2O 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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Literature
1.
Chalon J, Patel C, Ali M, Ramanathan S, Capan L, Tang CK, Turndorf H (1979) Humidity and the anesthetized patient. Anesthesiology 50:195–198PubMedCrossRef
2.
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
3.
Kapadia FN (2001) Factors associated with blocked tracheal tubes. Intensive Care Med 27:1679–1681PubMedCrossRef
4.
Lellouche F, Taille S, Maggiore SM, Qader S, L’Her E, Deye N et al (2004) Influence of ambient and ventilator output temperatures on performance of heated-wire humidifiers. Am J Respir Crit Care Med 170:1073–1079PubMedCrossRef
5.
Lellouche F, Taille S, Lefrancois F, Deye N, Maggiore SM, Jouvet P, Ricard JD, Fumagalli B, Brochard L (2009) Humidification performance of 48 passive airway humidifiers: comparison with manufacturer data. Chest 135:276–286PubMedCrossRef
6.
Boqué MC, Gualis B, Sandiumenge A, Rello J (2004) Endotracheal tube intraluminal diameter narrowing after mechanical ventilation: use of acoustic reflectometry. Intensive Care Med 30:2204–2209PubMedCrossRef
7.
Shah C, Kollef MH (2004) Endotracheal tube intraluminal volume loss among mechanically ventilated patients. Crit Care Med 32:120–125PubMedCrossRef
8.
Villafane MC, Cinnella G, Lofaso F, Isabey D, Harf A, Lemaire F, Brochard L (1996) Gradual reduction of endotracheal tube diameter during mechanical ventilation via different humidification devices. Anesthesiology 85:1341–1349PubMedCrossRef
9.
Jaber S, Pigeot J, Fodil R, Maggiore S, Harf A, Isabey D, Brochard L, Louis B (2004) Long-term effects of different humidification systems on endotracheal tube patency: evaluation by the acoustic reflection method. Anesthesiology 100:782–788PubMedCrossRef
10.
Lacherade JC, Auburtin M, Cerf C, Van de Louw A, Soufir L, Rebufat Y, Rezaiguia S, Ricard JD, Lellouche F, Brun-Buisson C, Brochard L (2005) Impact of humidification systems on ventilator-associated pneumonia: a randomized multicenter trial. Am J Respir Crit Care Med 172:1276–1282PubMedCrossRef
11.
Siempos II, Vardakas KZ, Kopterides P, Falagas ME (2007) Impact of passive humidification on clinical outcomes of mechanically ventilated patients: a meta-analysis of randomized controlled trials. Crit Care Med 35:2843–2851PubMedCrossRef
12.
Prin S, Chergui K, Augarde R, Page B, Jardin F, Vieillard-Baron A (2002) Ability and safety of a heated humidifier to control hypercapnic acidosis in severe ARDS. Intensive Care Med 28:1756–1760PubMedCrossRef
13.
Morán I, Bellapart J, Vari A, Mancebo J (2006) Heat and moisture exchangers and heated humidifiers in acute lung injury/acute respiratory distress syndrome patients. Effects on respiratory mechanics and gas exchange. Intensive Care Med 32:524–531PubMedCrossRef
14.
Iotti GA, Olivei MC, Palo A, Galbusera C, Veronesi R, Comelli A, Brunner JX, Braschi A (1997) Unfavorable mechanical effects of heat and moisture exchangers in ventilated patients. Intensive Care Med 23:399–405PubMedCrossRef
15.
Kapadia FN, Bajan KB, Singh S, Mathew B, Nath A, Wadkar S (2001) Changing patterns of airway accidents in intubated ICU patients. Intensive Care Med 27:296–300PubMedCrossRef
16.
Girault C, Breton L, Richard JC, Tamion F, Vandelet P, Aboab J, Leroy J, Bonmarchand G (2003) Mechanical effects of airway humidification devices in difficult to wean patients. Crit Care Med 31:1306–1311PubMedCrossRef
17.
Lellouche F, Qader S, Taille S, Lyazidi A, Brochard L (2006) Under-humidification and over-humidification during moderate induced hypothermia with usual devices. Intensive Care Med 32:1014–1021PubMedCrossRef
18.
American Association for Respiratory Care (1992) AARC clinical practice guideline: humidification during mechanical ventilation. Respir Care 37:887–890
19.
Brochard L, Rua F, Lorino H, Lemaire F, Harf A (1991) Inspiratory pressure support compensates for the additional work of breathing caused by the endotracheal tube. Anesthesiology 75:739–745PubMedCrossRef
20.
Rumbak MJ, Walsh FW, Anderson WM, Rolfe MW, Solomon DA (1999) Significant tracheal obstruction causing failure to wean in patients requiring prolonged mechanical ventilation: a forgotten complication of long-term mechanical ventilation. Chest 115:1092–1095PubMedCrossRef
21.
Cabello B, Morán I, Manero E, Manzanares E, Mancebo J (2007) Comparison of two humidificator systems on endotracheal tube resistance. Intensive Care Med 33(Suppl 2):A(532)
22.
Branson RD (2006) Humidification of respired gases during mechanical ventilation: mechanical considerations. Respir Care Clin N Am 12:253–261PubMed
23.
Lellouche F, Mancebo J, Jolliet P, Roeseler J, Schortgen F, Dojat M, Cabello B, Bouadma L, Rodriguez P, Maggiore S, Reynaert M, Mersmann S, Brochard L (2006) A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. Am J Respir Crit Care Med 174:894–900PubMedCrossRef
24.
Cabello B, Thille AW, Roche-Campo F, Brochard L, Gomez FJ, Mancebo J (2010) Physiological comparison of three spontaneous breathing trials in difficult-to-wean patients. Intensive Care Med 36:1171–1179PubMedCrossRef
25.
Maggiore SM, Lellouche F, Pigeot J, Taille S, Deye N, Durrmeyer X, Richard JC, Mancebo J, Lemaire F, Brochard L (2003) Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury. Am J Respir Crit Care Med 167:1215–1224PubMedCrossRef
26.
Fernández MD, Piacentini E, Blanch L, Fernández R (2004) Changes in lung volume with three systems of endotracheal suctioning with and without pre-oxygenation in patients with mild-to-moderate lung failure. Intensive Care Med 30:2210–2215PubMedCrossRef
27.
Thomachot L, Viviand X, Arnaud S, Boisson C, Martin CD (1998) Comparing two heat and moisture exchangers, one hydrophobic and one hygroscopic, on humidifying efficacy and the rate of nosocomial pneumonia. Chest 114:1383–1389PubMedCrossRef
28.
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
29.
Shapiro M, Wilson RK, Casar G, Bloom K, Teague RB (1986) Work of breathing through different sized endotracheal tubes. Crit Care Med 14:1028–1031PubMedCrossRef
30.
Iotti GA, Olivei MC, Braschi A (1999) Mechanical effects of heat-moisture exchangers in ventilated patients. Crit Care 3:R77–82PubMedCrossRef
31.
Fiastro JF, Habib MP, Quan SF (1988) Pressure support compensation for inspiratory work due to endotracheal tubes and demand continuous positive airway pressure. Chest 93:499–505PubMedCrossRef
32.
Pelosi P, Solca M, Ravagnan I, Tubiolo D, Ferrario L, Gattinoni L (1996) Effects of heat and moisture exchangers on minute ventilation, ventilatory drive, and work of breathing during pressure-support ventilation in acute respiratory failure. Crit Care Med 24:1184–1188PubMedCrossRef
33.
Cohen IL, Weinberg PF, Fein IA, Rowinski GS (1988) Endotracheal tube occlusion associated with the use of heat and moisture exchangers in the intensive care unit. Crit Care Med 16:277–279PubMedCrossRef
34.
Roustan JP, Kienlen J, Aubas P, Aubas S, du Cailar J (1992) Comparison of hydrophobic heat and moisture exchangers with heated humidifier during prolonged mechanical ventilation. Intensive Care Med 18:97–100PubMedCrossRef
35.
Martin C, Papazian L, Perrin G, Bantz P, Gouin F (1992) Performance evaluation of three vaporizing humidifiers and two heat and moisture exchangers in patients with minute ventilation greater than 10 L/min. Chest 102:1347–1350PubMedCrossRef
36.
Wright PE, Marini JJ, Bernard GR (1989) In vitro versus in vivo comparison of endotracheal tube airflow resistance. Am Rev Respir Dis 140:10–16PubMedCrossRef
37.
Straus C, Louis B, Isabey D, Lemaire F, Harf A, Brochard L (1998) Contribution of the endotracheal tube and the upper airway to breathing workload. Am J Respir Crit Care Med 157:23–30PubMed
38.
El-Khatib MF, Husari A, Jamaleddine GW, Ayoub CM, Bou-Khalil P (2008) Changes in resistances of endotracheal tubes with reductions in the cross-sectional area. Eur J Anaesthesiol 25:275–279PubMedCrossRef
39.
Vassilakopoulos T, Zakynthinos S, Roussos C (1998) The tension-time index and the frequency/tidal volume ratio are the major pathophysiologic determinants of weaning failure and success. Am J Respir Crit Care Med 158:378–385PubMed
Metadata
Title
Comparison of the effects of two humidifier systems on endotracheal tube resistance
Authors
Indalecio Morán
Belén Cabello
Elizabeth Manero
Jordi Mancebo
Publication date
01-11-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 11/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-011-2351-9

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