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 and a long term 10-week randomised cross-over studies comparing a heated humidifier (HH) to a heat-and-moisture exchanger (HME) in children with established tracheostomies. Participants were assessed for clinical events, clinical examination findings, airway cytokine levels and airway secretion viscoelasticity.
Results: Fifteen and 14 children were recruited to the short and long term studies respectively. Children wearing the HH had decreased respiratory examination score (p < 0.001) and improved oxygenation (p=0.012) but no change in clinical events over the short-term. There was a decrease in acute clinical events (p=0.008) 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.
Conclusion: Over 20 hours use of HH compared to HME improved work of breathing. Over a longer 10 week treatment period HH resulted in decreased adverse clinical events.
Footnotes
- Dr. David Grant McNamara, MBChB, FRACP, PhD, Starship Children’s Hospital, Auckland, New Zealand, davidmc{at}adhb.govt.nz
CONFLICTS OF INTERESTS, Dr McNamara - advisory board member for Glaxo Smith Kline NZ - received travel and conference accommodation from Boehringer Ingelheim. Professor Asher - has no relevant conflicts of interest. Professor Rubin - Research grants from the NIH, CF Foundation, Denny Hamlin Foundation, Glaxo SmithKline, Teleflex Medical, Reckitt Benckiser, and Fisher & Paykel to study airway mucus clearance and therapies - Patents held on aerosol surfactant and aerosol Dapsone for the therapy of inflammatory airways disease - Research grant and International Registry to study plastic bronchitis - Consultant to Philips Respironics, Pharmaxis, Boehringer Ingelheim Bayer, and GSK. Mr Alistair Stewart - has no relevant conflicts of interest. Dr Byrnes -received grants from Health Research Council of NZ -Conference organiser for national respiratory conference that is sponsored by Boerhinger Ingelheim
SOURCES OF FINANCIAL SUPPORT: The study was sponsored by Fisher & Paykel Healthcare who manufacture the heated humidifier used in this study. Dr McNamara’s salary was supported by Fisher & Paykel Healthcare and also the Foundation for Research Science and Technology and Joan Mary Reynolds Fellowship.
- Copyright © 2013 by Daedalus Enterprises Inc.
