Document Detail


Long-term mechanical ventilation with hygroscopic heat and moisture exchangers used for 48 hours: a prospective clinical, hygrometric, and bacteriologic study.
MedLine Citation:
PMID:  12626991     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether use of a hygroscopic heat and moisture exchanger (HME) for 48 hrs without change affects its efficiency and the level of bacterial colonization in long-term mechanically ventilated medical intensive care unit patients. DESIGN: Prospective, randomized clinical study evaluating two hygroscopic HMEs. SETTING: Medical intensive care unit at a university teaching hospital. PATIENTS: Long-term mechanically ventilated medical intensive care unit patients, including chronic obstructive pulmonary disease patients. INTERVENTIONS: Patients were randomly allocated to one of the two HMEs studied (Hygrolife and EdithFlex) and changed every 48 hrs. Devices in both groups could be changed if hygrometric measurements indicated insufficient humidity delivery. MEASUREMENTS AND MAIN RESULTS: Daily measurements of inspired gas temperature and relative and absolute humidity. In addition, cultures of tracheal aspirations and both patient and ventilator sides of the device were performed after 48 hrs of use. Ventilatory variables and clinical indicators of efficient humidification were also recorded. Prolonged use of both HMEs was safe and efficient (no tracheal tube occlusion occurred). Mean duration of mechanical ventilation was 20 days. Both clinical indicators and hygrometric measurements showed that both devices performed well during 48 hrs. Absolute humidity with EdithFlex was significantly higher on day 0 and day 1 than with Hygrolife. Absolute humidity measured in chronic obstructive pulmonary disease patients was identical to that measured in the rest of the study population. Tracheal colonization and HME colonization were similar with both HMEs. Bacterial contamination of the ventilator side of both devices was markedly low. CONCLUSIONS: These two purely hygroscopic HMEs provided safe and efficient humidification during a 48-hr period of use in long-term mechanically ventilated medical intensive care unit patients, including chronic obstructive pulmonary disease patients. In addition, they maintained ventilatory circuits clean, despite the absence of filtering media. The cost of mechanical ventilation is consequently reduced.
Authors:
Alexandre Boyer; Guillaume Thiéry; Serge Lasry; Etienne Pigné; Amar Salah; Arnaud de Lassence; Didier Dreyfuss; Jean-Damien Ricard
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Critical care medicine     Volume:  31     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-03-10     Completed Date:  2003-04-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  823-9     Citation Subset:  AIM; IM    
Affiliation:
Services de Réanimation Médicale, Hôpital Louis Mourier (Assistance Publique-Hôpitaux de Paris), Colombes, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Colony Count, Microbial
Cost Control
Disposable Equipment / economics,  standards
Equipment Contamination / statistics & numerical data
Equipment Design / standards
Female
Humans
Humidity
Infection Control
Long-Term Care
Male
Middle Aged
Nebulizers and Vaporizers / economics,  standards*
Prospective Studies
Pulmonary Disease, Chronic Obstructive / complications,  therapy*
Respiration, Artificial / economics,  instrumentation*
Respiratory Insufficiency / complications,  therapy*
Safety
Sputum / microbiology
Time Factors
Trachea / microbiology
Treatment Outcome
Wettability

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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