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Original Research: CRITICAL CARE MEDICINE |

Humidification Performance of 48 Passive Airway Humidifiers: Comparison With Manufacturer Data

François Lellouche, MD, PhD; Solenne Taillé, Eng; Frédéric Lefrançois, Eng; Nicolas Deye, MD, MSc; Salvatore Maurizio Maggiore, MD, PhD; Philippe Jouvet, MD, PhD; Jean-Damien Ricard, MD, PhD; Bruno Fumagalli, Eng; Laurent Brochard, MD; and Groupe de travail sur les Respirateurs de l'AP-HP
Author and Funding Information

*From the Service de Réanimation Médicale (Mrs. Taillé, Mr. Lefrançois, and Dr. Brochard), Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Albert Chenevier-Henri-Mondor, Créteil, France; Service de Soins Intensifs de Chirurgie Cardiaque (Dr. Lellouche), Centre de Recherche Hôpital Laval, Université Laval, Québec City, QC, Canada; Service de Réanimation Médicale (Dr. Deye), Hôpital Lariboisière, Paris, France; Istituto di Anestesiologia e Rianimazione-Università Cattolica Policlinico A. Gemelli (Dr. Maggiore), Rome, Italy; Service de Réanimation Médicale Pédiatrique (Dr. Jouvet), Hôpital Necker-Enfants Malades, Paris, France; Service de Réanimation Médicale (Dr. Ricard), Hôpital Louis Mourier, Hôpitaux de Paris, Colombes, Paris, France; and Pharmacie Centrale des Hôpitaux-Assistance Publique-Hôpitaux de Paris (Mr. Fumagalli), Paris, France.

Correspondence to: François Lellouche, Unité de soins intensifs de chirurgie cardiaque, Centre de Recherche Hôpital Laval, Université Laval, 2725, Chemin Sainte-Foy, QC, Canada, G1V 4G5; e-mail: francois.lellouche@crhl.ulaval.ca


Presented in part at the 14th Annual Congress of the European Society of Intensive Care Medicine, Geneva, Switzerland, September 30 to October 3, 2001.

Dr. Brochard, as director of the research laboratory, received a grant from the Hudson Company of $10,000 in 2002, and a grant from Fisher & Paykel Company of $8,700 in 2001, with $10,000 in 2002 to the same laboratory. The other authors have no conflict of interest to declare.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(2):276-286. doi:10.1378/chest.08-0679
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Introduction:  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.

Method:  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.

Results:  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.

Conclusions:  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.

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