PURPOSE: Heat-moisture exchanger filters (HMEFs) reduce equipment costs, filter bacteria, eliminate ventilator ‘tubing rainout’, and reduce nosocomial pneumonia rate, compared to traditional heated bath humidifiers (HBH). American Association for Respiratory Care (AARC) guidelines recommend HMEFs be used for ≤; 96 hours due to the development of thick sputum. We evaluated the effect of a new Supplemental Humidity Device (SHD) for HMEFs (HME Booster; Ulti-Mist, King Systems)on sputum characteristics over time in an intensive care unit (ICU).
METHODS: Patients (Pts) requiring mechanical ventilation (MV) in the ICU were placed on the SHD-HMEF and monitored for sputum viscosity and flex tubing condensate on a routine daily basis until extubation. Sputum viscosity was graded on a catheter sputum suction score [1=Watery: no sputum remains, 2=Moderate: some sputum remains and easily irrigated, 3=Thick: most sputum remains, not easily irrigated]. Condensation was graded by a flex tubing condensate score (Cond), [0=Dry, 1=Mist, 2=Drops, 3=Condensate]. SHD-HMEF were placed on 35 Pts, (mean±SD) age 61±21 years, with a pre-extubation length-of-use of 8 ±2.84 with a range of 1 to 11 days.
RESULTS: Data are displayed as mean±SE. One patient (3%) out of 35 Pts required HBH change-over due to Grade 3 sputum. Day 1 Visc score was 1.8±0.16 and remained unchanged until extubation (Repeated measures ANOVA; p=.91). Day 1 Cond Score 2.3±0.16. In addition, there was a significant correlation between Cond and Visc scores (R=0.2; p=0.03).
CONCLUSION: Our evaluation revealed that adding a SHD to an HMEF maintained an acceptable sputum viscosity during MV thereby extending HMEF length-of-use.
CLINICAL IMPLICATIONS: This evaluation suggests that SHD added to HMEFs may benefit sputum viscosity and extend HMEF length-of-use ≥96 hours.
DISCLOSURE: Frank Austan, No Financial Disclosure Information; No Product/Research Disclosure Information