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Safety of Combined Heat and Moisture Exchanger Filters in Long-term Mechanical Ventilation

Jean-Marc Hurni; François Feihl; Romain Lazor; Philippe Leuenberger; Claude Perret
Author and Funding Information

Affiliations: From the Institut de Physiopathologie Clinique, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,  From the Division de Pneumologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Affiliations: From the Institut de Physiopathologie Clinique, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,  From the Division de Pneumologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland


1997 by the American College of Chest Physicians


Chest. 1997;111(3):686-691. doi:10.1378/chest.111.3.686
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Abstract

Study objective: To evaluate the safety of a combined heat and moisture exchanger filter (HMEF) for the conditioning of inspired gas in long-term mechanical ventilation (MV).

Design: Randomized controlled trial.

Setting: Medical ICU in a large teaching hospital.

Patients: One hundred fifteen consecutive patients who required ≥48 h of MV.

Interventions: Patients were randomized at intubation time (day 1) to receive inspired gas conditioned either by a water-bath humidifier heated at 32°C (HWBH) or by an HMEF (Hygroster; DAR; Mirandola, Italy).

Measurements and main results: The two study groups were comparable in terms of primary pathologic condition at the time of hospital admission, disease severity as measured by the Simplified Acute Physiology Score, and ICU mortality. They did not differ with respect to ventilator days per patient (mean±SD: HMEF, 7.6±6.5; HWBH, 7.8±5.8), incidence of endotracheal tube obstruction (HMEF, 0/59; HWBH, 1/56), and incidence of hypothermic episodes (HMEF, five; HWBH, two). In 41 patients receiving MV for ≥5 days, the morphologic integrity of respiratory epithelium was evaluated on day 1 and day 5, using a cytologic examination of tracheal aspirate smears. The state of ciliated epithelium was scored on a scale from 0 (poorest integrity) to 1,200 (maximum integrity), according to a well-described method. In both patient groups, the scores slightly but significantly decreased from day 1 to day 5 (mean±SD: HWBH, from 787±104 to 745±88; HMEF, from 813±79 to 739±62; p<0.01 for both groups); there were no statistically significant differences between groups.

Conclusions: These data indicate acceptable safety of HMEFs of the type used in the present study for long-term mechanical ventilation.


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