NDLI: Heated humidification versus heat and moisture exchangers for ventilated adults and children.

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Heated humidification versus heat and moisture exchangers for ventilated adults and children.

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Heated humidification versus heat and moisture exchangers for ventilated adults and children.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Kelly, Margaret Gillies, Donna Todd, David A. Lockwood, Catherine
Abstract	BACKGROUND: Humidification by artificial means must be provided when the upper airway is bypassed during mechanical ventilation. Heated humidification (HH) and heat and moisture exchangers (HMEs) are the most commonly used types of artificial humidification in this situation. OBJECTIVES: To determine whether HHs or HMES are more effective in preventing mortality and other complications in people who are mechanically ventilated. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 4) and MEDLINE, EMBASE and CINAHL (January, 2010) to identify relevant randomized controlled trials. SELECTION CRITERIA: We included randomized controlled trials comparing HMEs to HHs in mechanically ventilated adults and children. We included randomized crossover studies. DATA COLLECTION AND ANALYSIS: We assessed the quality of each study and extracted the relevant data. Where appropriate, results from relevant studies were meta-analyzed for individual outcomes. MAIN RESULTS: We included 33 trials with 2833 participants; 25 studies were parallel group design (n = 2710) and 8 crossover design (n = 123). Only 3 included studies reported data for infants or children. There was no overall effect on artificial airway occlusion, mortality, pneumonia, or respiratory complications; however, the PaCO(2) and minute ventilation were increased when HMEs were compared to HHs and body temperature was lower. The cost of HMEs was lower in all studies that reported this outcome. There was some evidence that hydrophobic HMEs may reduce the risk of pneumonia and that blockages of artificial airways may be increased with the use of HMEs in certain subgroups of patients. AUTHORS' CONCLUSIONS: There is little evidence of an overall difference between HMEs and HHs. However, hydrophobic HMEs may reduce the risk of pneumonia and the use of an HMEs may increase artificial airway occlusion in certain subgroups of patients. Therefore, HMEs may not be suitable for patients with limited respiratory reserve or prone to airway blockage. Further research is needed relating to hydrophobic versus hygroscopic HMEs and the use of HMEs in the pediatric and neonatal populations. As the design of HMEs evolves, evaluation of new generation HMEs will also need to be undertaken.
File Format	HTM / HTML
ISSN	00032999
Issue Number	4
Volume Number	111
e-ISSN	15267598
Journal	Anesthesia & Analgesia
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2010-10-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Discipline Anesthesiology Hot Temperature Therapeutic Use Humidity Respiration, Artificial Methods Adult Child Humans Standards Randomized Controlled Trials As Topic Adverse Effects Mortality Comparative Study Journal Article Review
Content Type	Text
Resource Type	Article
Subject Domain (in MeSH)	Eukaryota Therapeutics Investigative Techniques Physical Phenomena Biological Phenomena Persons
Subject	Anesthesiology and Pain Medicine

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