Low inspired gas temperature and respiratory complications in very low birth weight infants

doi:10.1016/S0022-3476(89)80567-0

The Journal of Pediatrics

Volume 114, Issue 3, March 1989, Pages 438-442

https://doi.org/10.1016/S0022-3476(89)80567-0 Get rights and content

We analyzed 3705 measurements of inspired gas temperature in the first 96 hours of life, with concurrent measurements of ventilator variables and arterial oxygen tension, to determine any relationship to respiratory sequelae in 149 infants assisted by artificial ventilation. All management was with one type of ventilator (model IV100B, Sechrist Industries Inc., Anaheim, Calif.) and one type of humidifier (model MR 500, Fisher and Paykel, Auckland, New Zealand), and Infants were placed under radiant heaters. Outcome for Infants weighing ≥1500 gm at birth was no different at low (≤36.5°C) versus high (>36.5°C) values of mean inspired gas temperature during the first 96 hours. However, infants weighing <1500 gm at birth had less respiratory morbidity at the higher temperatures; there was a reduction in the incidence of pneumothorax from 43% at low to 13% at high temperatures (p=0.006) and a reduction in the severity of chronic lung disease, measured as mean Fio₂ at 29 days in survivors, from 37.2% at low to 27.5% at high temperatures (p=0.001). Clinical evaluation of the humidiffer, as it was used in this study, suggested that temperature settings <36.5°C were associated with inspired gas humidity between 28 and 36 mg H₂O/L. For any humidifier, there may be a critical threshold for Inspired gas humidity below which the risk of respiratory complications in very low birth weight babies is increased. This hypothesis requires rigorous scrutiny by controlled trial. In future studies, direct measurements of inspired gas humidify are needed to make a precise estimate of the optimal level.

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Citation Excerpt :
Exposure to 5 minutes of cold, dry gas resulted in increased airway resistance, decreased compliance, and increased work of breathing.8 Tarnow-Mordi et al16 noted an increased incidence of pneumothorax and severity of BPD in infants <1500 g exposed to cold, dry gas. Likewise, airway plugging, atelectasis, hypoxia, and infection may be seen when cold, dry gas is used for CPAP.17
To assess whether the addition of heated humidified gas (HHG) at delivery and until neonatal unit arrival improved admission temperatures of preterm infants.
This multicenter, randomized controlled trial was performed in New Zealand and The Netherlands. Infants <32 weeks' gestation who required respiratory support after delivery were randomized to either cold, dry gas or HHG from birth. Standard measures to prevent hypothermia included heated delivery rooms, the use of radiant warmers, body wrap, and head covering. The primary outcome was axillary temperature in the normothermic (36.5-37.5°C) range on admission to a neonatal intensive care unit. Secondary outcomes were measures of respiratory support and neonatal morbidities. The effect of humidification was analyzed by the use of logistic regression.
Of 203 randomized infants, 100 received HHG (humidifier set to 37°C) and 103 received cold, dry gas. In the HHG group, 69 (69%) were normothermic compared with 57 (55%) in the cold, dry gas group (unadjusted OR 1.8, 95% CI 1.01-3.19). A greater number of infants <28 weeks were normothermic on admission in the HHG group (24/35; ie, 69%) compared with the cold, dry gas group (16/38; ie, 42%; P = .03). In addition, 2 (2%) infants in the HHG group had admission temperatures <35.5°C compared with 12 (12%) in the cold, dry gas group (P = .007). Respiratory and short-term outcomes were not different.
Adding HHG during respiratory support in preterm infants from birth increased the incidence of normothermia at admission.

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¹: Supported by grants from Action Research, the Scottish Chest Heart and Stroke Association, the Department of Health and Social Security, and the Children's Nationwide Medical Research Fund.

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Low inspired gas temperature and respiratory complications in very low birth weight infants1

Br J Anaesth

Br J Anaesth

Lancet

Lancet

Lancet

Airflow patterns and ciliary activity in the trachea after tracheotomy

Acta Otolaryngol (Stockh)

Effect of humidification of anaesthetic gases on static compliance

Anesth Analg

Lack of association between barotrauma and air leak in hyaline membrane disease

Arch Dis Child