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

Critical Care

Volumn 21, Issue 1, 2017, Pages

  Vargas, Maria ^a   Chiumello, Davide ^b   Sutherasan, Yuda ^c   Ball, Lorenzo ^d   Esquinas, Antonio M ^e   Pelosi, Paolo ^d   Servillo, Giuseppe ^a  

^a UNIVERSITY OF NAPLES FEDERICO II   (Italy)

^b UNIVERSITY OF MILAN   (Italy)

^c MAHIDOL UNIVERSITY   (Thailand)

^d UNIVERSITY OF GENOA   (Italy)

^e HOSPITAL MORALES MESEGUER   (Spain)

Author keywords

Artificial airway occlusion; Heat and moisture exchangers; Heated humidifiers; Mortality; Pneumonia

Indexed keywords

AIRWAY OBSTRUCTION; ANESTHESIOLOGY THERAPEUTIC DEVICE; ARTICLE; ARTIFICIAL VENTILATION; CRITICALLY ILL PATIENT; HEAT AND MOISTURE EXCHANGER; HEATED HUMIDIFIER; HUMAN; META ANALYSIS; MORTALITY; PNEUMONIA; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); SYSTEMATIC REVIEW; ADULT; CRITICAL ILLNESS; DRUG THERAPY; EQUIPMENT DESIGN; HEAT; HUMIDIFIER; INCIDENCE; PROCEDURES; REGRESSION ANALYSIS; RESPIRATION CONTROL; STANDARDS;

ADULT; AIRWAY MANAGEMENT; AIRWAY OBSTRUCTION; CRITICAL ILLNESS; EQUIPMENT DESIGN; HOT TEMPERATURE; HUMANS; HUMIDIFIERS; INCIDENCE; RANDOMIZED CONTROLLED TRIALS AS TOPIC; REGRESSION ANALYSIS; RESPIRATION, ARTIFICIAL;

EID: 85019740832     PISSN: 13648535     EISSN: 1466609X     Source Type: Journal    
DOI: 10.1186/s13054-017-1710-5     Document Type: Article

References (87)

1. American Association for Respiratory Care, Restrepo RD, Walsh BK. Humidification during invasive and noninvasive mechanical ventilation: 2012. Respir Care. 2012;57(5):782-8.
2. Branson RD, Chatburn RL. Humidification of inspired gases during mechanical ventilation. Respir Care. 1993;38:461-8.
3. Lellouche F, Qader S, Taille S, Lyazidi A, Brochard L. Influence of ambient temperature and moisture ventilation on passive and active heat and moisture exchange. Respir Care. 2014;59(5):637-43.
4. Kelly M, Gillies D, Todd DA, 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.
5. Dixon-Woods M, Shaw RL, Agarwal S, Smith JA. The problem of appraising qualitative research. Qual Saf Health Care. 2004;13:223-5.
6. Denzin N, Riessman C. Narrative analysis. J Commun. 1995;45:177-84.
7. PRISMA guideline. http://www.prisma-statement.org/
8. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L. Comparison of two methods to detect publication bias in meta-analysis. JAMA. 2006;295(6):676-80.
9. Bissonnette B. Passive or active inspired gas humidification increases thermal steady-state temperatures in anesthetized infants. Anesth Analg. 1989;69(6):783-7.
10. Bissonette B, Sessler DI, La Flamme P. Passive and active inspired gas humidification in infants and children. Anesthesiology. 1989;71(3):350-4.
11. Campbell RS, Davis Jr K, Johannigman JA, Branson RD. The effects of passive humidifier dead space on respiratory variables in paralyzed and spontaneously breathing patients. Respir Care. 2000;45(3):306-12.
12. Deriaz H, Fiez N, Lienhart A. Comparative effects of a hygrophobic filter and a heated humidifier on intraoperative hypothermia. Ann Fr Anesth Reanim. 1992;11(2):145-9.
13. Girault C, Breton L, Richard J, Tamion F, Vandelet P, Aboab J, et al. Mechanical effects of airway humidification devices in difficult to wean patients. Crit Care Med. 2003;31(5):1306-11.
14. Goldberg ME, Epstein R, Rosenblum F, Larijani GE, Marr A, Lessin J, et al. Do heated humidifiers and heat and moisture exchangers prevent temperature drop during lower abdominal surgery? J Clin Anesth. 1992;4(1):16-20.
15. Iotti GA, Olivei MC, Palo A, Galbusera C, Veronesi R, Comelli A, et al. Unfavorable mechanical effects of heat and moisture exchangers in ventilated patients. Intensive Care Med. 1997;23(4):399-405.
16. Le Bourdelles G, Mier L, Fiquet B, Djedaini K, Saumon G, Coste F, et al. 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.
17. Linko K, Honkavaara P, Nieminen MT. Heated humidification in major abdominal surgery. Eur J Anaesthesiol. 1984;1(3):285-91.
18. MacIntyre NR, Anderson HR, Silver RM, Schuler FR, Coleman RE. Pulmonary function in mechanically ventilated patients during 24-hour use of a hygroscopic condensor humidifier. Chest. 1983;84(5):560-4.
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.
20. Pelosi P, Solca M, Ravagnan I, Tubiolo D, Ferrario L, Gattinoni L. Effects of heat and moisture exchangers on minute ventilation, ventilatory drive, and work of breathing during pressure-support ventilation in acute respiratory failure. Crit Care Med. 1996;24(7):1184-8.
21. Ricard JD, Markowicz P, Djedaini K, Mier L, Coste F, Dreyfuss D. Bedside evaluation of efficient airway humidification during mechanical ventilation of the critically ill. Chest. 1999;115(6):1646-52.
22. Roustan JP, Kienlen J, Aubas S, Du Cailar J. Evaluation of an exchange filter on heat and humidity in long duration mechanical ventilation. Comparison with heated humidification. Ann Fr Anesth Reanim. 1989;8 Suppl:R275.
23. Thomachot L, Viviand X, Lagier P, Dejode JM, Albanese J, Martin C. Measurement of tracheal temperature is not a reliable index of total respiratory heat loss in mechanically ventilated patients. Crit Care. 2001;5(1):24-30.
24. Alagar R. Heated humidification reduces saline instillations, nebulized therapy, and cost in long term ventilated patients (abstract). American Journal of Respiratory and Critical Care Medicine. American Thoracic Society 2000 International Conference; May 5-10; Toronto, Canada. 2000; Vol. 161; 3 Suppl: A552.
25. Branson RD, Davis Jr K, Campbell RS, Johnson DJ, Porembka DT. Humidification in the intensive care unit: prospective study of a new protocol utilizing heated humidification and a hydroscopic condenser humidifier. Chest. 1993;104(6):1800-05.
26. Branson RD, Campbell RS, Johannigman JA, Ottaway M, Davis Jr K, Luchette FA, et al. Comparison of conventional heated humidification with a new active hygroscopic heat and moisture exchanger in mechanically ventilated patients. Respir Care. 1999;44(8):912-17.
27. Christiansen S, Renzing K, Hirche H, Reidemeister JC. Measurements of inspired air humidity as provided by different humidifiers. Anasthesiol Intensivmed Notfallmed Schmerzther. 1998;33(5):300-5.
28. Cohen IL, Weinberg PF, Fein IA, Rowinski GS. 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.
29. Conti G, De Blasi RA, Rocco M, Pelaia P, Antonelli M, Bufi M, et al. Effects of the heat-moisture exchangers on dynamic hyperinflation of mechanically ventilated COPD patients. Intensive Care Med. 1990;16(7):441-3.
30. Dias MD, Pellacine EN, Zechineli CA. The new system of gaseous mixture humidification and heating of respirators: comparative study. Rev Assoc Med Bras. 1993;39(4):207-12.
31. Dias MD, Pellacine EN, Zechineli CA. Bacterial aerosol generated by mechanical ventilators: comparative study. Rev Assoc Med Bras. 1997;43(1):15-20.
32. Fujita Y, Imanaka H, Fujino Y, Takeuchi M, Tomita T, Mashimo T, Nishimura M. Effect of humidifying devices on the measurement of tidal volume by mechanical ventilators. J Anesth. 2006;20(3):166-72.
33. Jaber S, Pigeot J, Fodil R, Maggiore S, Harf A, Isabey D, et al. Long-term effects of different humidification systems on endotracheal tube patency: evaluation by the acoustic reflection method. Anesthesiology. 2004;100(4):782-8.
34. Johnson PA, Raper RF, Fisher MDM. The impact of heat and moisture exchanging humidifiers on work of breathing. Anaesth Intensive Care. 1995;23(6):697-701.
35. Kranabetter R, Leier M, Kammermeier D, Just HM, Heuser D. The effects of active and passive humidification on ventilation-associated nosocomial pneumonia. Anaesthesist. 2004;53(1):29-35.
36. Lellouche F, Qader S, Taille S, Lyazidi A, Brochard L. Under-humidification and over-humidification during moderate induced hypothermia with usual devices. Intensive Care Med. 2006;32(7):1014-21.
37. Luchetti M, Pigna A, Gentili A, Marraro G. Evaluation of the efficiency of heat and moisture exchangers during paediatric anaesthesia. Paediatr Anaesth. 1999;9(1):39-45.
38. MacLeod R, Bucknall T. Mechanical ventilation with heated humidifiers or with heat and moisture exchangers with microbiological filters did not reduce ventilator associated pneumonia in adults. Evid Based Nursing. 2006;9(3):82.
39. Martin C, Papazian L, Perrin G, Bantz P, Gouin F. Performance evaluation of three vaporizing humidifiers and two heat and moisture exchangers in patients with minute ventilation > 10 L/min. Chest. 1992;102(5):1347-50.
40. Martin C, Thomachot L, Quinio B, Viviand X, Albanese J. Comparing two heat and moisture exchangers with one vaporizing humidifier in patients with minute ventilation greater than 10 L/min. Chest. 1995;107(5):1411-5.
41. McEvoy MT, Carey TJ. Shivering and rewarming after cardiac surgery: comparison of ventilator circuits with humidifier and heated wires to heat and moisture exchangers. Am J Crit Care. 1995;4(4):293-9.
42. Nakagawa NK, Macchione M, Petrolino HM, Guimaraes ET, King M, Saldiva PH, et al. Effects of a heat and moisture exchanger and a heated humidifier on respiratory mucus in patients undergoing mechanical ventilation. Crit Care Med. 2000;28(2):312-7.
43. Prat G, Renault A, Tonnelier JM, Goetghebeur D, Oger E, Boles JM, et al. Influence of the humidification device during acute respiratory distress syndrome. Intensive Care Med. 2003;29(12):2211-5.
44. 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.
45. Rathgeber J, Henze D, Zuchner K. Air conditioning with a high-performance HME (heat and moisture exchanger) - an effective and economical alternative to active humidifiers in ventilated patients. A prospective and randomized clinical study. Anaesthesist. 1996;45(6):518-25.
46. Rathgeber J, Betker T, Zuchner K. Measurement of water vapour pressure in the airways of mechanically ventilated patient using different types of humidifier. Anasthesiol Intensivmed Notfallmed Schmerzther. 2001;36(9):560-5.
47. Schiffmann H, Rethgeber J, Singer D, Harms K, Bolli A, Zuchner K. Airway humidification in mechanically ventilated neonates and infants: A comparative study of a heat and moisture exchanger vs. a heated humidifier using a new fast-response capacitive humidity sensor. Crit Care Med. 1997;25(10):1755-60.
48. Takumi Y, Aochi O. Effect of emphysematous expansion and humidification on the intrapulmonary gas exchange. Anaesthesist. 1970;19(10):373-83.
49. Thomachot L, Viviand X, Arnaud S, Vialet R, Albanese J, Martin C. Preservation of humidity and heat of respiratory gases in spontaneously breathing, tracheostomized patients. Acta Anaesthesiol Scand. 1998;42(7):841-4.
50. Wilmshurst JM, Rahman MA, Shah V, Elton P, Long D, Martin N. The heat moisture exchange device (HME) in neonatal ventilation. Am J Perinatol. 1999;16(1):13-6.
51. Boyer A, Vargas F, Hilbert G, Gruson D, Mousset-Hovaere M, Castaing Y, Dreyfuss D, Ricard JD. Small dead space heat and moisture exchangers do not impede gas exchange during noninvasive ventilation: a comparison with a heated humidifier. Intensive Care Med. 2010;36(8):1348-54.
52. Arieli R, Daskalovic Y, Ertracht O, Arieli Y, Adir Y, Abramovich A, Halpern P. Flow resistance, work of breathing of humidifiers, and endotracheal tubes in the hyperbaric chamber. Am J Emerg Med. 2011;29(7):725-30.
53. Thille AW, Bertholon JF, Becquemin MH, Roy M, Lyazidi A, Lellouche F, Pertusini E, Boussignac G, Maître B, Brochard L. Aerosol delivery and humidification with the Boussignac continuous positive airway pressure device. Respir Care. 2011;56(10):1526-32.
54. Retamal J, Castillo J, Bugedo G, Bruhn A. Airway humidification practices in Chilean intensive care units. Rev Med Chil. 2012;140(11):1425-30.
55. Tonnelier A, Lellouche F, Bouchard PA, L'Her E. Impact of humidification and nebulization during expiratory limb protection: an experimental bench study. Respir Care. 2013;58(8):1315-22.
56. Schena E, Saccomandi P, Cappelli S, Silvestri S. Mechanical ventilation with heated humidifiers: measurements of condensed water mass within the breathing circuit according to ventilatory settings. Physiol Meas. 2013;34(7):813-21.
57. Ehrmann S, Roche-Campo F, Sferrazza Papa GF, Isabey D, Brochard L, Apiou-Sbirlea G. REVA research network. Aerosol therapy during mechanical ventilation: an international survey. Intensive Care Med. 2013;39(6):1048-56.
58. Alonso-Iñigo JM, Almela A, Albert A, Carratalá JM, Fas MJ. Active humidification with Boussignac CPAP: in vitro study of a new method. Respir Care. 2013;58(4):647-54.
59. Schena E, Quaranta A, Saccomandi P, Silvestri S. Performances of heated humidifiers in mechanical ventilation: a preliminary intra-breath analysis. Conf Proc IEEE Eng Med Biol Soc. 2013;2013:934-7.
60. Lellouche F, Pignataro C, Maggiore SM, Girou E, Deye N, Taillé S, Fischler M, Brochard L. Short-term effects of humidification devices on respiratory pattern and arterial blood gases during noninvasive ventilation. Respir Care. 2012;57(11):1879-86.
61. Schena E, Saccomandi P, Ramandi C, Silvestri S. A novel control strategy to improve the performances of heated wire humidifiers inartificial neonatal ventilation. Physiol Meas. 2012;33(7):1199-211.
62. Morán I, Cabello B, Manero E, Mancebo J. Comparison of the effects of two humidifier systems on endotracheal tube resistance. Intensive Care Med. 2011;37(11):1773-9.
63. Schena E, De Paolis E, Silvestri S. Gas pre-warming for improving performances of heated humidifiers in neonatal ventilation. Conf Proc IEEE Eng Med Biol Soc. 2011;2011:1205-8.
64. Lorente L, Blot S, Rello J. New issues and controversies in the prevention of ventilator-associated pneumonia. Am J Respir Crit Care Med. 2010;182(7):870-6.
65. Verta A, Schena E, Silvestri S. Mathematical model and minimal measurement system for optimal control of heated humidifiers in neonatal ventilation. Med Eng Phys. 2010;32(5):475-81.
66. Kirkegaard L, Andersen BN, Jensen S. Moistening of inspired air during respirator treatment. Comparison between the water-bath evaporator and hygroscopic moisture heat exchanger. Ugeskr Laeger. 1987;149(3):152-5.
67. Martin C, Perrin G, Gevaudan MJ, Saux P, Gouin F. Heat and moisture exchangers and vaporizing humidifiers in the intensive care unit. Chest. 1990;97(1):144-9.
68. Misset B, Escudier B, Rivara D, Leclercq B, Nitenberg G. Heat and moisture exchanger vs heated humidifier during long-term mechanical ventilation. A prospective randomized study. Chest. 1991;100(1):160-3.
69. Roustan JP, Kienlen J, Aubas P, Aubas S, du Cailar J. Comparison of hydrophobic heat and moisture exchangers with heated humidifier during prolonged mechanical ventilation. Intensive Care Med. 1992;18(2):97-100.
70. Dreyfuss D, Djedaini K, Gros I, Mier L, LeBourdelles G, Cohen Y, et al. Mechanical ventilation with heated humidifiers or heat and moisture exchangers: effects on patient colonization and incidence of nosocomial pneumonia. Am J Respir Crit Care Med. 1995;151(4):986-92.
71. Branson RD, Davis Jr K, Brown R, Rashkin M. Comparison of three humidification techniques during mechanical ventilation: patient selection, cost and infections considerations. Respir Care. 1996;41(9):809-16.
72. Villafane MC, Cinnella G, Lofaso F, Isabey D, Harf A, Lemaire F, et al. Gradual reduction of endotracheal tube diameter during mechanical ventilation via different humidification devices. Anesthesiology. 1996;85(6):1341-9.
73. Boots R, Howe S, George N, Harris F, Faoagali J. Clinical utility of hygroscopic heat and moisture exchangers in intensive care patients. Crit Care Med. 1997;25(10):1707-12.
74. Hurni J, Feihl F, Lazor R, Leuenberger P, Perret C. Safety of combined heat and moisture exchanger filters in long term mechanical ventilation. Chest. 1997;111(3):686-91.
75. Kirton O, De Haven B, Morgan J, Morejon O, Civetta J. A prospective, randomised comparison of an in-line heat moisture exchange filter and heated wire humidifiers: rates of ventilator-associated early-onset (community-acquired) or late-onset (hospital-acquired) pneumonia and incidence of endotracheal tube occlusion. Chest. 1997;112(4):1055-9.
76. Kollef MH, Shapiro SD, Boyd V, Silver P, Von Harz B, Trovillion E, et al. A randomized clinical trial comparing an extended-use hygroscopic condenser humidifier with heated-water humidification in mechanically ventilated patients. Chest. 1998;113(3):759-67.
77. Luchetti M, Stuani A, Castelli G, Marraro G. Comparison of three different humidification systems during prolonged mechanical ventilation. Minerva Anestesiol. 1998;64(3):75-81.
78. Memish ZA, Oni GA, Djazmati W, Cunningham G, Mah MW. A randomized clinical trial to compare the effects of a heat and moisture exchanger with a heated humidifying system on the occurrence rate of ventilator-associated pneumonia. Am J Infect Control. 2001;29(5):301-5.
79. Diaz RB, Barbosa DA, Bettencourt AR, Vianna LAC, Gir E, Guimaraes T. Evalution [sic] the use of hygroscopic humidifier filters to prevent nosocomial pneumonia. Acta Paulista de Enfermagem. 2002;15(4):32-44.
80. Lacherade JC, Auburtin M, Cerf C, Van de Louw A, Soufir L, Rebufat Y, et al. Impact of humidification systems on ventilator-associated pneumonia: a randomized multicenter trial. Am J Respir Crit Care Med. 2005;172(10):1276-82.
81. Lorente L, Lecuona M, Jimenez A, Mora ML, Sierra A. Ventilator-associated pneumonia using a heated humidifier or a heat and moisture exchanger: a randomized controlled trial. Crit Care. 2006;10(4):R116.
82. Boots RJ, George N, Faoagali JL, Druery J, Dean K, Heller RF. Double-heater-wire circuits and heat-and-moisture exchangers and the risk of ventilator-associated pneumonia. Crit Care Med. 2006;34(3):687-93.
83. Oguz S, Deger I. Ventilator-associated pneumonia in patients using HME filters and heated humidifiers. Ir J Med Sci. 2013;182(4):651-5.
84. Bench S. Humifification in thr long-term ventilated patients; a systematic review. Intens Crit Care Nurs. 2033;19:75-84.
85. Hess DR, Kallstrom TJ, Mottram CD, et al. American Association for Respiratory Care are of the ventilator circuit and its relation to ventilator associated pneumonia. Respir Care. 2003;48:869-79.
86. Kola A, Eckmanns T, Gaistmeier P. Efficacy of heat and moisturing exchangers in preventing ventilator-associated pneumonia: meta-analysis of randomized controlled trials. Intensive Care Med. 2005;31:5-11.
87. Siempos II, Vardakas KZ, Kopterides P, Falagas ME. Impact of passive humidifcation on clinical outcomes of mechanically ventilated patients: a meta-analysis of randomized controlled trials. Crit Care Med. 2007;35:2843-51.