Heat and moisture exchangers (HMEs) are increasingly used in the ICU for gas conditioning during mechanical ventilation. Independent assessments of the humidification performance of HMEs are scarce. The aim of the present study was thus to assess the humidification performance of a large number of adult HMEs.
We assessed 48 devices using a bench test apparatus that simulated real-life physiologic ventilation conditions. Thirty-two devices were described by the manufacturers as HMEs, and 16 were described as antibacterial filters. The test apparatus provided expiratory gases with an absolute humidity (AH) of 35 mg H2O/L. The AH of inspired gases was measured after steady state using the psychrometric method. We performed three hygrometric measurements for each device, measured their resistance, and compared our results with the manufacturer data.
Of the 32 HMEs tested, only 37.5% performed well (≥ 30 mg H2O/L), while 25% performed poorly (< 25 mg H2O/L). The mean difference (± SD) between our measurements and the manufacturer data was 3.0 ± 2.7 mg H2O/L for devices described as HMEs (maximum, 8.9 mg H2O/L) [p = 0.0001], while the mean difference for 36% of the HMEs was > 4 mg H2O/L. The mean difference for the antibacterial filters was 0.2 ± 1.4 mg H2O/L. The mean resistance of all the tested devices was 2.17 ± 0.70 cm H2O/L/s.
Several HMEs performed poorly and should not be used as HMEs. The values determined by independent assessments may be lower than the manufacturer data. Describing a device as an HME does not guarantee that it provides adequate humidification. The performance of HMEs must be verified by independent assessment.