Chest
Volume 97, Issue 1, January 1990, Pages 144-149
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Clinical Investigations in Critical Care
Heat and Moisture Exchangers and Vaporizing Humidifiers in the Intensive Care Unit

https://doi.org/10.1378/chest.97.1.144Get rights and content

A prospective, randomized, controlled study was undertaken to compare the Pall Ultipor breathing circuit filter (PUBCF), a heat-and-moisture exchanger, and heated hot water systems (HHWSs) in ICU patients submitted to controlled mechanical ventilation. Humidification of inspired gas and bacterial contamination of breathing circuits were evaluated. During the study, there were six episodes of tracheostomy tube (TT) occlusion in six patients included in the PUBCF group. No patient out of 42 included in the HHWS group experienced this complication (p<0.01). There were 4 percent of days with thick and tenacious bronchial secretions in the PUBCF group and no case in the HHWS group (p<0.02). In the PUBCF group, 23 percent of days with hypothermia were noted as opposed to 12 percent in the HHWS group (p<0.01). Fewer breathing circuits were found to be contaminated in the PUBCF group (11 percent) than in the HHWS group (54 percent, p<0.01). In patients with an organism growing in bronchial specimens, the same organism was found to contaminate the breathing circuit in 10 percent of cases in the PUBCF group and 77 percent of cases in the HHWS (p<0.01). We conclude that, in the conditions of this study, the PUBCF did not provide sufficient humidification of inspired gas in ICU patients. Protection against contamination of breathing circuits was effective, but 10 percent of patients remained at risk for this complication. (Chest 1990; 97:144-49)

Section snippets

METHODS

This study was approved by the Committee on Human Research of our institution. From January to August 1987, we included in the study all patients admitted to the ICU, in whom a controlled MV (CMV) of more than 24 hours was planned. This was done to avoid including patients admitted for a short-term (overnight) postoperative MV. No patient was excluded because of prognosis, diagnosis or presence of pulmonary infection. They were randomly assigned to one of two groups.

Patients in the PUBCF group

RESULTS

The study was interrupted after the death of a patient in the PUBCF group from a total obstruction of his TT. Replacement of the TT was unsuccessful despite the combined efforts of three critical care physicians. Results of the 31 patients included in the PUBCF group and the 42 patients included in the HHWS group are reported. In the PUBCF group, 299 days of ventilation were analyzed and 589 days in the HHWS group. Homogeneity between the PUBCF and the HHWS groups was controlled for the

DISCUSSION

This prospective, randomized, controlled study clearly demonstrates the increased risk of TT occlusion in ICU patients submitted to prolonged CMV with a PUBCF. Clinical reports on the potential benefits or hazards associated with the use of HMEs in ICU patients are limited. Most studies included only intraoperative or stable postoperative patients.20, 21, 22 Since these patients did not present with pathologic lungs or required less than 10 L/minute volume, definite conclusions cannot be drawn

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Manuscript received February 13; revision accepted June 19.

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