A Prospective, Randomized Comparison of an In-Line Heat Moisture Exchange Filter and Heated Wire Humidifiers

Kirton, Orlando C.; DeHaven, Bryan; Morgan, J.; Morejon, Orlando; Civetta, Joseph M.

doi:10.1378/chest.112.4.1055

Cited by 157 publications

(23 citation statements)

References 19 publications

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“…The random sequence generation was adequate in seven studies [75, 78–83], adequate allocation concealment was present in three studies [77–79] and adequate blinding was present in two studies [75, 76]. Complete outcome data were reported from 10 studies [66–70, 73–76, 80–83].…”

Section: Resultsmentioning

confidence: 99%

Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) in adult critically ill patients: a systematic review, meta-analysis and meta-regression of randomized controlled trials

et al. 2017

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BackgroundThe aims of this systematic review and meta-analysis of randomized controlled trials are to evaluate the effects of active heated humidifiers (HHs) and moisture exchangers (HMEs) in preventing artificial airway occlusion and pneumonia, and on mortality in adult critically ill patients. In addition, we planned to perform a meta-regression analysis to evaluate the relationship between the incidence of artificial airway occlusion, pneumonia and mortality and clinical features of adult critically ill patients.MethodsComputerized databases were searched for randomized controlled trials (RCTs) comparing HHs and HMEs and reporting artificial airway occlusion, pneumonia and mortality as predefined outcomes. Relative risk (RR), 95% confidence interval for each outcome and I 2 were estimated for each outcome. Furthermore, weighted random-effect meta-regression analysis was performed to test the relationship between the effect size on each considered outcome and covariates.ResultsEighteen RCTs and 2442 adult critically ill patients were included in the analysis. The incidence of artificial airway occlusion (RR = 1.853; 95% CI 0.792–4.338), pneumonia (RR = 932; 95% CI 0.730–1.190) and mortality (RR = 1.023; 95% CI 0.878–1.192) were not different in patients treated with HMEs and HHs. However, in the subgroup analyses the incidence of airway occlusion was higher in HMEs compared with HHs with non-heated wire (RR = 3.776; 95% CI 1.560–9.143). According to the meta-regression, the effect size in the treatment group on artificial airway occlusion was influenced by the percentage of patients with pneumonia (β = -0.058; p = 0.027; favors HMEs in studies with high prevalence of pneumonia), and a trend was observed for an effect of the duration of mechanical ventilation (MV) (β = -0.108; p = 0.054; favors HMEs in studies with longer MV time).ConclusionsIn this meta-analysis we found no superiority of HMEs and HHs, in terms of artificial airway occlusion, pneumonia and mortality. A trend favoring HMEs was observed in studies including a high percentage of patients with pneumonia diagnosis at admission and those with prolonged MV. However, the choice of humidifiers should be made according to the clinical context, trying to avoid possible complications and reaching the appropriate performance at lower costs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1710-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) in adult critically ill patients: a systematic review, meta-analysis and meta-regression of randomized controlled trials

et al. 2017

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“…Although HHC units are unlikely to affect hospital stays, they are expensive, and thus, the overall balance between medical benefits and patient satisfaction requires scrutiny. Furthermore, although ventilator-associated pneumonia [14] improbable after brief exposure, water condensates may reduce the functions of respiratory gas monitors and ventilators. Second, vasoconstrictors used to treat hypotension in the sitting position might influence body temperature changes, for example, ephedrine and phenylephrine have been reported to reduce core temperature falls during surgery [15,16].…”

Section: Discussionmentioning

confidence: 99%

The effect of warmed inspired gases on body temperature during arthroscopic shoulder surgery under general anesthesia

Kim

Chang

et al. 2013

Korean J Anesthesiol

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BackgroundPerioperative hypothermia can develop easily during shoulder arthroscopy, because cold irrigation can directly influence core body temperature. The authors investigated whether active warming and humidification of inspired gases reduces falls in core body temperature and allows redistribution of body heat in patients undergoing arthroscopic shoulder surgery under general anesthesia.MethodsPatients scheduled for arthroscopic shoulder surgery were randomly assigned to receive either room temperature inspired gases using a conventional respiratory circuit (the control group, n = 20) or inspired gases humidified and heated using a humidified and electrically heated circuit (HHC) (the heated group, n = 20).ResultsCore temperatures were significantly lower in both groups from 30 min after anesthesia induction, but were significantly higher in the heated group than in the control group from 75 to 120 min after anesthesia induction.ConclusionsIn this study the use of a humidified and electrically heated circuit did not prevent core temperature falling during arthroscopic shoulder surgery, but it was found to decrease reductions in core temperature from 75 min after anesthesia induction.

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“…The authors found lower VAP rates with the use of HMEs compared with heated humidifiers [76]. However, these lower rates of VAP were mostly found in only one among five included studies [77]. In a subsequent meta-analysis, no difference was found in VAP rates between HH and HMEs [78].…”

Section: Selecting the Appropriate Humidifiermentioning

confidence: 99%

“…Yet, in the same review, Paco2 and minute ventilation were found to be higher with HMEs suggesting that heated humidifiers could be better options in patients with limited respiratory reserve [86]. A characteristic disadvantage of heated humidifiers is the formation of condensate in the circuit, which was associated in earlier studies with an increased risk of nosocomial infections [77]. Despite the previously described finding, no difference was found in pneumonia rates between heated and passive humidifiers [86].…”

Section: Selecting the Appropriate Humidifiermentioning

confidence: 99%

Humidification during Mechanical Ventilation in the Adult Patient

Ashry

Modrykamien

2014

BioMed Research International

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Humidification of inhaled gases has been standard of care in mechanical ventilation for a long period of time. More than a century ago, a variety of reports described important airway damage by applying dry gases during artificial ventilation. Consequently, respiratory care providers have been utilizing external humidifiers to compensate for the lack of natural humidification mechanisms when the upper airway is bypassed. Particularly, active and passive humidification devices have rapidly evolved. Sophisticated systems composed of reservoirs, wires, heating devices, and other elements have become part of our usual armamentarium in the intensive care unit. Therefore, basic knowledge of the mechanisms of action of each of these devices, as well as their advantages and disadvantages, becomes a necessity for the respiratory care and intensive care practitioner. In this paper, we review current methods of airway humidification during invasive mechanical ventilation of adult patients. We describe a variety of devices and describe the eventual applications according to specific clinical conditions.

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A Prospective, Randomized Comparison of an In-Line Heat Moisture Exchange Filter and Heated Wire Humidifiers

Cited by 157 publications

References 19 publications

Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) in adult critically ill patients: a systematic review, meta-analysis and meta-regression of randomized controlled trials

Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) in adult critically ill patients: a systematic review, meta-analysis and meta-regression of randomized controlled trials

The effect of warmed inspired gases on body temperature during arthroscopic shoulder surgery under general anesthesia

Humidification during Mechanical Ventilation in the Adult Patient

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