Humidification Performance of Passive and Active Humidification Devices Within a Spontaneously Breathing Tracheostomized Cohort

Abstract

BACKGROUND: Most heat-and-moisture exchangers (HMEs) for patients with tracheostomy and spontaneously breathing are small and have suction ports that allow some expiratory gas to escape, which loses water vapor held in the expired gas. Recently, a heated-and-humidified high-flow system for spontaneously breathing patients with tracheostomy was developed. Little is known, however, about the humidifying performance of HMEs or heated-and-humidified high-flow systems for spontaneous breathing patients with a tracheostomy. OBJECTIVE: To investigate the humidifying performance of the HMEs and heated-and-humidified high-flow systems for spontaneously breathing patients with tracheostomy. METHODS: Adult spontaneously breathing subjects with tracheostomy and were enrolled when their respiratory parameters and S pO 2 were stable. We measured absolute humidity, relative humidity, and temperature by using a capacitance-type moisture sensor at the outlet of the tracheostomy tube. Heated-and-humidified high flow was delivered via the a humidifier and tracheostomy interface, and a selected HME. The subjects received heated-and-humidified high flow, after which an HME was used for humidification before switching back to a heated-and-humidified high-flow system. RESULTS: Ten subjects (5 men, 5 women; mean ؎ SD age, 72 ؎ 12 y) were enrolled. The admission diagnoses were neurologic (5 subjects), respiratory failure (3), and cardiac arrest (2). The APACHE (Acute Physiology and Chronic Health Evaluation) II score was 24 (interquartile range, 20-27). Tracheostomy was performed on day 7 (interquartile range, 5-11 d) after endotracheal intubation, and the duration of mechanical ventilation was 10 d (interquartile range, 6-11 d). The temperature with the HME was 29.9 ؎ 1.0°C and, during heated-and-humidified high-flow use was 35.3 ؎ 0.8°C (P < .001). With both the HME and the heated-and-humidified high-flow system, the relative humidity reached 100%; the absolute humidity with HME was 30.2 ؎ 1.8 mg/L, and, with the heated-and-humidified high-flow system, was 40.3 ؎ 1.8 mg/L (P < .001). CONCLUSIONS: In spontaneously breathing subjects with tracheostomy, an heated-and-humidified high-flow system achieved higher absolute humidity than did an HME.

A clinical practice evaluating the more appropriate airway humidification methods applied on patients with severe traumatic brain injury

“…Some previous studies [13,16] indicated that C method usually gains better SpO 2 , while our results showed that the SpO 2 was lower and respiratory rate was higher in group B and C than group A, and no difference was observed between group B and C. The reason may be that, the cold air flow in group A cause the airway contraction and prevent the oxygen exchange, and the supplement of oxygen to the patients diminished the differences between group B and C.…”

“…1C). The temperature of the atomizer tank is adjusted to 39-41 °C, and the temperature before entering the patient's airway is 35.3 °C according to a previous report [13]. The pipeline is non-polluted and not replaced.…”

The effect of high-flow nasal cannula on diaphragm dysfunction including paradoxical diaphragmatic contraction in the intensive care unit

“…HFNC did not affect decreased diaphragm contraction in this study ; however, it attenuated paradoxical diaphragm contraction. The work of breathing was decreased by HFNC in patients without diaphragm dysfunction as reported (10,11). The findings of this study suggest that HFNC may have the potential role to manage patients with paradoxical diaphragm contraction.…”

Short-Term Effects of an Active Heat-and-Moisture Exchanger During Invasive Ventilation

“…In subjects with tracheostomy who are spontaneously breathing, a heated-and-humidified high-flow system was reported to achieve higher absolute humidity than did an HME. 23 The active HME is increasingly being prescribed for long-term home mechanical ventilation as an alternative to heated humidifiers because it is lighter (42 g for the active HME vs 1.7 kg for the heated humidifier) and not cumbersome (the active HME consists of a mount catheter and a breathing filter connected to a booster vs several more components for the heated humidifier) and so it is able to facilitate the patient's movements. In addition to its opti-mum humidifying properties, which are particularly indicated for long-term invasive ventilation and similar to those of an active humidification system, as described elsewhere, 12,13 the active HME was found to share similarities and handling features with the HME.…”