Humidification and Heating of Inhaled Gas in Patients with Artificial Airway. A Narrative Review

Overview

Journal Rev Bras Ter Intensiva

Specialties Critical Care
General Medicine

Date 2018 May 10

PMID 29742220

Citations 8

Authors

Gustavo Adrian Plotnikow

Matias Accoce

Emiliano Navarro

Norberto Tiribelli

Affiliations

Soon will be listed here.

Abstract

Instrumentation of the airways in critical patients (endotracheal tube or tracheostomy cannula) prevents them from performing their function of humidify and heating the inhaled gas. In addition, the administration of cold and dry medical gases and the high flows that patients experience during invasive and non-invasive mechanical ventilation generate an even worse condition. For this reason, a device for gas conditioning is needed, even in short-term treatments, to avoid potential damage to the structure and function of the respiratory epithelium. In the field of intensive therapy, the use of heat and moisture exchangers is common for this purpose, as is the use of active humidification systems. Acquiring knowledge about technical specifications and the advantages and disadvantages of each device is needed for proper use since the conditioning of inspired gases is a key intervention in patients with artificial airway and has become routine care. Incorrect selection or inappropriate configuration of a device can have a negative impact on clinical outcomes. The members of the Capítulo de Kinesiología Intensivista of the Sociedad Argentina de Terapia Intensiva conducted a narrative review aiming to show the available evidence regarding conditioning of inhaled gas in patients with artificial airways, going into detail on concepts related to the working principles of each one.

Citing Articles

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References

Wilkes A . Heat and moisture exchangers. Structure and function. Respir Care Clin N Am. 1998; 4(2):261-79. View

Prat G, Renault A, Tonnelier J, Goetghebeur D, Oger E, Boles J . Influence of the humidification device during acute respiratory distress syndrome. Intensive Care Med. 2003; 29(12):2211-2215. DOI: 10.1007/s00134-003-1926-5. View

Prin S, Chergui K, Augarde R, Page B, Jardin F, Vieillard-Baron A . Ability and safety of a heated humidifier to control hypercapnic acidosis in severe ARDS. Intensive Care Med. 2002; 28(12):1756-60. DOI: 10.1007/s00134-002-1520-2. View

Lee M, Ford J, Hunt P, Ireland D, Swanson P . Bacterial retention properties of heat and moisture exchange filters. Br J Anaesth. 1992; 69(5):522-5. DOI: 10.1093/bja/69.5.522. View

Cohen I, Weinberg P, FEIN I, Rowinski G . Endotracheal tube occlusion associated with the use of heat and moisture exchangers in the intensive care unit. Crit Care Med. 1988; 16(3):277-9. DOI: 10.1097/00003246-198803000-00013. View

Iotti G, Olivei M, Braschi A . Mechanical effects of heat-moisture exchangers in ventilated patients. Crit Care. 2000; 3(5):R77-82. PMC: 137236. DOI: 10.1186/cc361. View

Thomachot L, Leone M, Razzouk K, Antonini F, Vialet R, Martin C . Randomized clinical trial of extended use of a hydrophobic condenser humidifier: 1 vs. 7 days. Crit Care Med. 2002; 30(1):232-7. DOI: 10.1097/00003246-200201000-00033. View

Parrilla F, Moran I, Roche-Campo F, Mancebo J . Ventilatory strategies in obstructive lung disease. Semin Respir Crit Care Med. 2014; 35(4):431-40. DOI: 10.1055/s-0034-1382155. View

Nava S, Navalesi P, Gregoretti C . Interfaces and humidification for noninvasive mechanical ventilation. Respir Care. 2008; 54(1):71-84. View

10.

Klompas M, Branson R, Eichenwald E, Greene L, Howell M, Lee G . Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014; 35 Suppl 2:S133-54. DOI: 10.1017/s0899823x00193894. View

11.

Forbes A . Temperature, humidity and mucus flow in the intubated trachea. Br J Anaesth. 1974; 46(1):29-34. DOI: 10.1093/bja/46.1.29. View

12.

Restrepo R, Walsh B . Humidification during invasive and noninvasive mechanical ventilation: 2012. Respir Care. 2012; 57(5):782-8. DOI: 10.4187/respcare.01766. View

13.

McCall J, Cahill T . Respiratory care of the burn patient. J Burn Care Rehabil. 2005; 26(3):200-6. View

14.

Pelosi P, Severgnini P, Selmo G, Corradini M, Chiaranda M, Novario R . In vitro evaluation of an active heat-and-moisture exchanger: the Hygrovent Gold. Respir Care. 2010; 55(4):460-6. View

15.

Kelly M, Gillies D, Todd D, Lockwood C . Heated humidification versus heat and moisture exchangers for ventilated adults and children. Cochrane Database Syst Rev. 2010; (4):CD004711. DOI: 10.1002/14651858.CD004711.pub2. View

16.

Lucato J, Tucci M, Schettino G, Adams A, Fu C, Forti Jr G . Evaluation of resistance in 8 different heat-and-moisture exchangers: effects of saturation and flow rate/profile. Respir Care. 2005; 50(5):636-43. View

17.

Campbell R, Davis Jr K, Johannigman J, Branson R . The effects of passive humidifier dead space on respiratory variables in paralyzed and spontaneously breathing patients. Respir Care. 2000; 45(3):306-12. View

18.

Le Bourdelles G, Mier L, Fiquet B, Djedaini K, Saumon G, Coste F . Comparison of the effects of heat and moisture exchangers and heated humidifiers on ventilation and gas exchange during weaning trials from mechanical ventilation. Chest. 1996; 110(5):1294-8. DOI: 10.1378/chest.110.5.1294. View

19.

Martin C, Papazian L, Perrin G, Saux P, Gouin F . Preservation of humidity and heat of respiratory gases in patients with a minute ventilation greater than 10 L/min. Crit Care Med. 1994; 22(11):1871-6. View

20.

Thomachot L, Boisson C, Arnaud S, Michelet P, Cambon S, Martin C . Changing heat and moisture exchangers after 96 hours rather than after 24 hours: a clinical and microbiological evaluation. Crit Care Med. 2001; 28(3):714-20. DOI: 10.1097/00003246-200003000-00019. View