nach oben

Intensive Care Medicine

Erschienen in:

01.04.2006 | Original

Heat and moisture exchangers and heated humidifiers in acute lung injury/acute respiratory distress syndrome patients. Effects on respiratory mechanics and gas exchange

verfasst von: Indalecio Morán, Judith Bellapart, Alessandra Vari, Jordi Mancebo

Erschienen in: Intensive Care Medicine | Ausgabe 4/2006

Einloggen, um Zugang zu erhalten

Abstract

Objective

To compare, in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) patients, the short-term effects of heat and moisture exchangers (HME) and heated humidifiers (HH) on gas exchange, and also on respiratory system mechanics when isocapnic conditions are met.

Design

Prospective open clinical study.

Setting

Intensive Care Service.

Patients

Seventeen invasively ventilated ALI/ARDS patients.

Intervention

The study was performed in three phases: (1) determinations were made during basal ventilatory settings with HME; (2) basal ventilatory settings were maintained and HME was replaced by an HH; (3) using the same HH, tidal volume (Vt) was decreased until basal PaCO₂ levels were reached. FiO₂, respiratory rate and PEEP were kept unchanged.

Measurements and results

Respiratory mechanics, Vd_phys, gas exchange and hemodynamic parameters were obtained at each phase. By using HH instead of HME and without changing Vt, PaCO₂ decreased from 46 ± 9 to 40 ± 8 mmHg (p < 0.001) and Vd_phys decreased from 352 ± 63 to 310 ± 74 ml (p < 0.001). Comparing the first phase with the third, Vt decreased from 521 ± 106 to 440 ± 118 ml (p < 0.001) without significant changes in PaCO₂, Vd/Vt decreased from 0.69 ± 0.11 to 0.62 ± 0.12 (p < 0.001), plateau airway pressure decreased from 25 ± 6 to 21 ± 6 cmH₂O (p < 0.001) and respiratory system compliance improved from 35 ± 12 to 42 ± 15 ml/cmH₂O (p < 0.001). PaO₂ remained unchanged in the three phases.

Conclusions

Reducing dead space with the use of HH decreases PaCO₂ and more importantly, if isocapnic conditions are maintained by reducing Vt, this strategy improves respiratory system compliance and reduces plateau airway pressure

Cook D, De Jonghe B, Brochard L, Brun-Buisson C (1998) Influence of airway management on ventilator-associated pneumonia: evidence from randomized trials. JAMA 279:781–787PubMedCrossRef

Williams R, Rankin N, Smith T, Galler D, Seakins P (1996) Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa. Crit Care Med 24:1920–1929PubMedCrossRef

Dreyfuss D, Djedaini K, Gros I, Mier L, Le Bourdelles G, Cohen Y, Estagnasie P, Coste F, Boussougant Y (1995) Mechanical ventilation with heated humidifiers or heat and moisture exchangers: effects on patient colonization and incidence of nosocomial pneumonia. Am J Respir Crit Care Med 151:986–992PubMed

Lucangelo U, Blanch L (2004) Dead space. Intensive Care Med 30:576–579PubMedCrossRef

Richecoeur J, Lu Q, Vieira SR, Puybasset L, Kalfon P, Coriat P, Rouby JJ (1999) Expiratory washout versus optimization of mechanical ventilation during permissive hypercapnia in patients with severe acute respiratory distress syndrome. Am J Respir Crit Care Med 160:77–85PubMed

Campbell RS, Davis Jr K, Johannigman JA, Branson RD (2000) The effects of passive humidifier dead space on respiratory variables in paralyzed and spontaneously breathing patients. Respir Care 45:306–312PubMed

Wald M, Jeitler V, Lawrenz K, Weninger M, Kirchner L (2005) Effect of the Y-piece of the ventilation circuit on ventilation requirements in extremely low birth weight infants. Intensive Care Med 31:1095–1100PubMedCrossRef

Prat G, Renault A, Tonnelier JM, Goetghebeur D, Oger E, Boles JM, L'Her E (2003) Influence of the humidification device during acute respiratory distress syndrome. Intensive Care Med 29:2211–2215PubMedCrossRef

Prin S, Chergui K, Augarde R, Page B, Jardin F, Vieillard-Baron A (2002) Ability and safety of a heated humidifier to control hypercapnic acidosis in severe ARDS. Intensive Care Med 28:1756–1760PubMedCrossRef

10.

Claramunt A, Bellapart J, Cancio B, Morán I, Mancebo J (2001) Influence of heat and moisture exchangers on dead space and gas exchange in patients with respiratory distress. Intensive Care Med 27:S246 (A434)

11.

Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R (1994) Report of the American–European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. Intensive Care Med 20:225–232PubMedCrossRef

12.

Bacher A (2005) Effects of body temperature on blood gases. Intensive Care Med 31:24–27PubMedCrossRef

13.

Fletcher R, Jonson B, Cumming G, Brew J (1981) The concept of deadspace with special reference to the single breath test for carbon dioxide. Br J Anaesth 53:77–88PubMedCrossRef

14.

The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Eng J Med 342:1301–1308CrossRef

15.

Taskar V, John J, Larsson A, Wetterberg T, Jonson B (1995) Dynamics of carbon dioxide elimination following ventilator resetting. Chest 108:196–202PubMedCrossRef

16.

Nuckton TJ, Alonso JA, Kallet RH, Daniel BM, Pittet JF, Eisner MD, Matthay MA (2002) Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med 346:1281–1286PubMedCrossRef

17.

Thorens JB, Jolliet P, Ritz M, Chevrolet JC (1996) Effects of rapid permissive hypercapnia on hemodynamics, gas exchange, and oxygen transport and consumption during mechanical ventilation for the acute respiratory distress syndrome. Intensive Care Med 22:182–191PubMedCrossRef

18.

Viitanen A, Salmenpera M, Heinonen J (1990) Right ventricular response to hypercarbia after cardiac surgery. Anesthesiology 73:393–400PubMedCrossRef

19.

Carvalho CR, Barbas CS, Medeiros DM, Magaldi RB, Lorenzi Filho G, Kairalla RA, Deheinzelin D, Munhoz C, Kaufmann M, Ferreira M, Takagaki TY, Amato MB (1997) Temporal hemodynamic effects of permissive hypercapnia associated with ideal PEEP in ARDS. Am J Respir Crit Care Med 156:1458–1466PubMed

20.

Vieillard-Baron A, Schmitt JM, Augarde R, Fellahi JL, Prin S, Page B, Beauchet A, Jardin F (2001) Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis. Crit Care Med 29:1551–1555PubMedCrossRef

21.

Hotchkiss JR, Blanch L, Murias G, Adams AB, Olson DA, Wangensteen OD, Leo PH, Marini JJ (2000) Effects of decreased respiratory frequency on ventilator-induced lung injury. Am J Respir Crit Care Med 161:463–468PubMed

22.

Bshouty Z, Younes M (1992) Effect of breating pattern and level of ventilation on pulmonary fluid filtration in dog lung. Am Rev Respir Dis 145:372–376PubMed

23.

de Durante G, del Turco M, Rustichini L, Cosimini P, Giunta F, Hudson LD, Slutsky AS, Ranieri VM (2002) ARDSNet lower tidal volume ventilatory strategy may generate intrinsic positive end-expiratory pressure in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 165:1271–1274PubMedCrossRef

24.

Vieillard-Baron A, Prin S, Augarde R, Desfonds P, Page B, Beauchet A, Jardin F (2002) Increasing respiratory rate to improve CO2 clearance during mechanical ventilation is not a panacea in acute respiratory failure. Crit Care Med 30:1407–1412PubMedCrossRef

25.

Richard JC, Brochard L, Breton L, Aboab J, Vandelet P, Tamion F, Maggiore SM, Mercat A, Bonmarchand G (2002) Influence of respiratory rate on gas trapping during low volume ventilation of patients with acute lung injury. Intensive Care Med 28:1078–1083PubMedCrossRef

26.

Blanch L, Fernandez R, Benito S, Mancebo J, Net A (1987) Effect of PEEP on the arterial minus end-tidal carbon dioxide gradient. Chest 92:451–454PubMedCrossRef

27.

Blanch L, Lucangelo U, Lopez-Aguilar J, Fernandez R, Romero PV (1999) Volumetric capnography in patients with acute lung injury: effects of positive end-expiratory pressure. Eur Respir J 13:1048–1054PubMedCrossRef

28.

Beydon L, Uttman L, Rawal R, Jonson B (2002) Effects of positive end-expiratory pressure on dead space and its partitions in acute lung injury. Intensive Care Med 28:1239–1245PubMedCrossRef

29.

Uttman L, Jonson B (2003) A prolonged postinspiratory pause enhances CO₂ elimination by reducing airway dead space. Clin Physiol Funct Imaging 23:252–256PubMedCrossRef

30.

Coffey RL, Albert RK, Robertson HT (1983) Mechanisms of physiological dead space response to PEEP after acute oleic acid lung injury. J Appl Physiol 55:1550–1557PubMed

31.

De Robertis E, Sigurdsson SE, Drefeldt B, Jonson B (1999) Aspiration of airway dead space. A new method to enhance CO₂ elimination. Am J Respir Crit Care Med 159:728–732PubMed

32.

De Robertis E, Servillo G, Jonson B, Tufano R (1999) Aspiration of dead space allows normocapnic ventilation at low tidal volumes in man. Intensive Care Med 25:674–679PubMedCrossRef

33.

De Robertis E, Servillo G, Tufano R, Jonson B (2001) Aspiration of dead space allows isocapnic low tidal volume ventilation in acute lung injury. Relationships to gas exchange and mechanics. Intensive Care Med 27:1496–1503PubMedCrossRef

34.

Ravenscraft SA, Burke WC, Nahum A, Adams AB, Nakos G, Marcy TW, Marini JJ (1993) Tracheal gas insufflation augments CO₂ clearance during mechanical ventilation. Am Rev Respir Dis 148:345–351PubMed

35.

Lacherade JC, Auburtin M, Cerf C, Van de Louw A, Soufir L, Rebuffat Y, Rezaiguia S, Ricard JD, Lellouche F, Brun-Buisson C, Brochard L (2005) Impact of humidification systems on ventilator-associated pneumonia: a randomized multicentre trial. AJRCCM DOI 10.1164/rccm.200408–1028OC

36.

Lellouche F, Taille S, Maggiore SM, Qader S, L'Her E, Deye N, Brochard L (2004) Influence of ambient and ventilator output temperatures on performance of heated-wire humidifiers. Am J Respir Crit Care Med 170:1073–1079PubMedCrossRef

37.

Jaber S, Pigeot J, Fodil R, Maggiore S, Harf A, Isabey D, Brochard L, Louis B (2004) Long-term effects of different humidification systems on endotracheal tube patency: evaluation by the acoustic reflection method. Anesthesiology 100:782–788PubMedCrossRef

38.

Ricard JD, Le Miere E, Markowicz P, Lasry S, Saumon G, Djedaini K, Coste F, Dreyfuss D (2000) Efficiency and safety of mechanical ventilation with a heat and moisture exchanger changed only once a week. Am J Respir Crit Care Med 161:104–109PubMed

Titel: Heat and moisture exchangers and heated humidifiers in acute lung injury/acute respiratory distress syndrome patients. Effects on respiratory mechanics and gas exchange
verfasst von: Indalecio Morán
Judith Bellapart
Alessandra Vari
Jordi Mancebo
Publikationsdatum: 01.04.2006
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 4/2006
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-006-0073-1

Neu im Fachgebiet AINS

18.04.2024 | Wirbelsäulenmetastase | Nachrichten

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Heat and moisture exchangers and heated humidifiers in acute lung injury/acute respiratory distress syndrome patients. Effects on respiratory mechanics and gas exchange

Abstract

Objective

Design

Setting

Patients

Intervention

Measurements and results

Conclusions

Neu im Fachgebiet AINS

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Hochrisiko-Eingriffe für postoperative Übelkeit

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

Update AINS

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Objective

Design

Setting

Patients

Intervention

Measurements and results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2006

Prescription of rh-APC differs substantially among western European countries

Activated protein C in daily practice

Management of mechanical ventilation in acute severe asthma: practical aspects

Year in review in intensive care medicine, 2005. III. Nutrition, pediatric and neonatal critical care, and experimental

Accidental ecstasy intoxication in an 8-month-old infant

Go with the flow—recruit the microcirculation!

Neu im Fachgebiet AINS

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Hochrisiko-Eingriffe für postoperative Übelkeit

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

Update AINS