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Research ArticleOriginal Research

Impact of Airway Humidification Strategy in Mechanically Ventilated COVID-19 Patients

Carole-Anne Lavoie-Bérard, Jean-Claude Lefebvre, Pierre-Alexandre Bouchard, Mathieu Simon and François Lellouche
Respiratory Care February 2022, 67 (2) 157-166; DOI: https://doi.org/10.4187/respcare.09314
Carole-Anne Lavoie-Bérard
département d’anesthésiologie et de soins intensifs, division de soins intensifs, Université Laval, Québec City, Canada.
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Jean-Claude Lefebvre
département d’anesthésiologie et de soins intensifs, division de soins intensifs, Université Laval, Québec City, Canada.
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Pierre-Alexandre Bouchard
centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Canada.
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Mathieu Simon
centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Canada.
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François Lellouche
centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec City, Canada.
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  • For correspondence: [email protected]
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Abstract

BACKGROUND: Humidification of inspiratory gases is mandatory in all mechanically ventilated patients in ICUs, either with heated humidifiers (HHs) or with heat and moisture exchangers (HMEs). In patients with COVID-19, the choice of the humidification device may have relevant impact on patients’ management as demonstrated in recent studies. We reported data from 2 ICUs using either HME or HH.

METHODS: Data from patients with COVID-19 requiring invasive mechanical ventilation during the first wave in 2 ICUs in Québec City were reviewed. In one ICU, HMEs were used, whereas heated-wire HHs were used in the other ICU. We compared ventilator settings and arterial blood gases at day one after adjustment of ventilator settings. Episodes of endotracheal tube occlusions (ETOs) or subocclusions and a strategy to limit the risk of under-humidification were reported. On a bench test, we measured humidity with psychrometry with HH at different ambient temperature and evaluated the relation with heater plate temperature.

RESULTS: We reported data from 20 subjects positive for SARS-Cov-2, including 6 in the ICU using HME and 14 in the ICU using HH. In the HME group, PaCO2 was higher (48 vs 42 mm Hg) despite higher minute ventilation (171 vs 145 mL/kg/min predicted body weight [PBW]). We also reported 3 ETOs occurring in the ICU using HH. The hygrometric bench study reported a strong correlation between heater plate temperatures of the HH and humidity delivered. After implementation of measures to avoid under-humidification, including heater plate temperature monitoring, no more ETOs occurred.

CONCLUSIONS: The choice of the humidification device used in subjects with COVID-19 had a relevant impact on ventilation efficiency (increased CO2 removal with lower dead space) and on complications related to low humidity, including ETOs that may be present with heated-wire HHs when used with high ambient temperatures.

  • heated humidification
  • heat and moisture exchanger
  • dead space
  • CO2
  • COVID-19
  • endotracheal tube occlusion

Footnotes

  • Correspondence: François Lellouche MD PhD, Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, 2725, Chemin Sainte-Foy, Québec, QC, Canada G1V 4G5. E-mail: francois.lellouche{at}criucpq.ulaval.ca
  • See the Related Editorial on Page 272

  • The authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://rc.rcjournal.com/.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (2)
Respiratory Care
Vol. 67, Issue 2
1 Feb 2022
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Impact of Airway Humidification Strategy in Mechanically Ventilated COVID-19 Patients
Carole-Anne Lavoie-Bérard, Jean-Claude Lefebvre, Pierre-Alexandre Bouchard, Mathieu Simon, François Lellouche
Respiratory Care Feb 2022, 67 (2) 157-166; DOI: 10.4187/respcare.09314

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Impact of Airway Humidification Strategy in Mechanically Ventilated COVID-19 Patients
Carole-Anne Lavoie-Bérard, Jean-Claude Lefebvre, Pierre-Alexandre Bouchard, Mathieu Simon, François Lellouche
Respiratory Care Feb 2022, 67 (2) 157-166; DOI: 10.4187/respcare.09314
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Keywords

  • heated humidification
  • heat and moisture exchanger
  • dead space
  • CO2
  • COVID-19
  • endotracheal tube occlusion

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