Abstract
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.
Footnotes
- Correspondence: David G McNamara MBChB FRACP PhD, Department of Paediatrics, Starship Children's Hospital, Park Road Grafton, Auckland 1024 New Zealand. E-mail: davidmc{at}adhb.govt.nz.
This study was partly supported by Fisher & Paykel Healthcare, which manufactures the heated humidifier used in this study. Dr McNamara has disclosed relationships with Fisher & Paykel Healthcare, GlaxoSmithKline, and Boehringer Ingelheim. Dr McNamara was partly supported by the New Zealand Foundation for Research Science and Technology, and a Joan Mary Reynolds fellowship. Dr Rubin has disclosed relationships with the United States National Institutes of Health, the Cystic Fibrosis Foundation, the Denny Hamlin Foundation, GlaxoSmithKline, Teleflex Medical, Reckitt Benckiser, Fisher & Paykel Healthcare, Philips Respironics, Pharmaxis, Boehringer Ingelheim, and Bayer. Dr Byrnes has disclosed relationships with the Health Research Council of New Zealand and Boehringer Ingelheim. The other authors have disclosed no conflicts of interest.
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