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Effects of a heat and moisture exchanger and a heated humidifier on respiratory mucus in patients undergoing mechanical ventilation

Nakagawa, Naomi Kondo BSc; Macchione, Mariangela PhD; Petrolino, Helen Maria Scapolan RN; Guimarães, Eliane Tigre BSc; King, Malcolm PhD; Saldiva, Paulo Hilário Nascimento MD, PhD; Lorenzi-Filho, Geraldo MD, PhD

Clinical Investigations

Objective: To evaluate the effects of a heat and moisture exchanger and a heated humidifier on respiratory mucus and transportability by cilia and cough in patients undergoing invasive mechanical ventilation (up to 72 hrs).

Design: Prospective, randomized, clinical study.

Setting: General intensive care unit and university research laboratory.

Patients: A total of 32 consecutive patients with acute respiratory failure, who were intubated and mechanically ventilated in the intensive care unit setting, were enrolled in the study.

Interventions: Patients were randomly assigned to receive as a humidifying system a heat and moisture exchanger (HME) or heated humidified water (HHW) at the onset of mechanical ventilation (time 0). Respiratory mucus samples were collected by suction using a sterile technique at time 0, 24, 48, and 72 hrs of mechanical ventilation.

Measurements and Main Results: Eleven patients were excluded from this study because of either extubation or death before 72 hrs of mechanical ventilation, leaving 12 patients in the HME group and nine patients in the HHW group. Ventilatory variables including minute volume, mean airway pressure, positive end-expiratory pressure, FIO2, as well as PaO2/FIO2 ratio, fluid balance (last 6 hrs), furosemide, and inotrope administration (last 4 hrs) were recorded.In vitromucus transportability by cilia was evaluated on the mucus-depleted frog palate model, and the results were expressed as the mucus transport rate. Cough clearance (an estimation of the interaction between the flow of air and the mucus lining the bronchial walls) was measured using a simulated cough machine, the results being expressed in millimeters. Mucus wettability was measured by the contact angle between a mucus sample drop and a flat glass surface. Mucus rheologic properties (mechanical impedance [log G*] and the ratio between viscosity and elasticity [tan δ]) were measured using a magnetic microrheometer at 1 and 100 cGy/sec deformation frequency. The two humidification groups were comparable in terms of the Acute Physiology and Chronic Health Evaluation II score, age, gender, ventilatory variables, fluid balance, use of inotropes, and furosemide.

Conclusion: Ours results indicate that air humidification with either HME or HHW at 32°C (89.6°F) has similar effects on mucus rheologic properties, contact angle, and transportability by cilia in patients undergoing mechanical ventilation, except for transportability by cough, which diminished after 72 hrs of mechanical ventilation in the HME group (p= .0441).

From the Faculdade de Medicina da Universidade de São Paulo, Brazil (Drs. Nakagawa, Macchione, Guimarães, Saldiva, and Lorenzi-Filho); Hospital Sírio Libanês, São Paulo, Brazil (Drs. Nakagawa and Petrolino); Universidade Federal de São Paulo, Brazil (Dr. Nakagawa); and Pulmonary Research Group, Edmonton, Canada (Dr. King).

Supported, in part, by FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo).

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