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Research ArticleOriginal Research

Short-Term Effects of an Active Heat-and-Moisture Exchanger During Invasive Ventilation

Annia F Schreiber, Piero Ceriana, Nicolino Ambrosino, Manuela Piran, Alberto Malovini and Annalisa Carlucci
Respiratory Care July 2019, respcare.06799; DOI: https://doi.org/10.4187/respcare.06799
Annia F Schreiber
Respiratory Intensive Care Unit, and Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Scientifico di Pavia, Pavia, Italy.
Division of Respirology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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  • For correspondence: [email protected]
Piero Ceriana
Respiratory Intensive Care Unit, and Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Scientifico di Pavia, Pavia, Italy.
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Nicolino Ambrosino
Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Montescano, Montescano Pavia, Italy.
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Manuela Piran
Respiratory Intensive Care Unit, and Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Scientifico di Pavia, Pavia, Italy.
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Alberto Malovini
Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri IRCCS, Istituto Scientifico di Pavia, Pavia, Italy.
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Annalisa Carlucci
Respiratory Intensive Care Unit, and Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Scientifico di Pavia, Pavia, Italy.
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Abstract

BACKGROUND: Humidification is a standard of care during invasive mechanical ventilation. Two types of devices are used for this purpose: heated humidifiers and heat-and-moisture exchangers (HME).

AIM: To compare the short-term physiologic effects of an active HME, with those of heated humidifiers and HMEs in terms of respiratory effort, ventilatory pattern, and arterial blood gases during invasive mechanical ventilation.

METHODS: We conducted a randomized crossover study with 3 different devices in 15 stable subjects who had a tracheostomy and were ventilator-dependent. Transdiaphragmatic pressure, ventilatory pattern, arterial blood gases, and dyspnea scale were recorded at baseline and at the end of a 20-min period with each device.

RESULTS: Compared with heated humidifiers, the active HME was associated with higher diaphragmatic pressure-time product per minute (117.10 [interquartile range {IQR} 34.58–298.60]) versus 80.86 (IQR, 25.46–110.55) cm H2O×s/min, P = .01), higher PaCO2 (48.50 [IQR, 40.65–53.70] vs 39.60 [IQR, 37.50–49.95]) mm Hg, P = .02) and lower pH (7.41 [IQR, 7.36–7.49] vs 7.45 [IQR, 7.40–7.51], P = .030) without any significant difference in ventilatory pattern. A significantly worse dyspnea scale score (active HME, 3 (2–4) vs heated humidifiers: 4 (3–5); P = .009) was also observed. No significant differences were seen between active HME and HME.

CONCLUSIONS: This study indicated that, compared with the heated humidifiers, the use of the active HME or the HME increased inspiratory effort, PaCO2, pH, and dyspnea in stable subjects who were tracheostomized and ventilator-dependent.

  • critical care
  • humidifiers
  • prolonged mechanical ventilation
  • tracheostomy
  • work of breathing
  • critically ill subjects

Footnotes

  • Correspondence: Annia F Schreiber MD, Division of Respirology, Department of Medicine, University Health Network. 585 University Ave., Peter Munk Building, 11th Floor, Toronto, ON M5G 2N2, Canada. E-mail: annia.schreiber{at}icloud.com.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2019 by Daedalus Enterprises
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Respiratory Care: 66 (4)
Respiratory Care
Vol. 66, Issue 4
1 Apr 2021
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Short-Term Effects of an Active Heat-and-Moisture Exchanger During Invasive Ventilation
Annia F Schreiber, Piero Ceriana, Nicolino Ambrosino, Manuela Piran, Alberto Malovini, Annalisa Carlucci
Respiratory Care Jul 2019, respcare.06799; DOI: 10.4187/respcare.06799

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Short-Term Effects of an Active Heat-and-Moisture Exchanger During Invasive Ventilation
Annia F Schreiber, Piero Ceriana, Nicolino Ambrosino, Manuela Piran, Alberto Malovini, Annalisa Carlucci
Respiratory Care Jul 2019, respcare.06799; DOI: 10.4187/respcare.06799
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Keywords

  • critical care
  • humidifiers
  • prolonged mechanical ventilation
  • tracheostomy
  • work of breathing
  • critically ill subjects

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