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机械通气重症监护病房患者使用的热湿交换器:呼吁对其性能进行独立评估。

Heat and moisture exchangers in mechanically ventilated intensive care unit patients: a plea for an independent assessment of their performance.

作者信息

Thiéry Guillaume, Boyer Alexandre, Pigné Etienne, Salah Amar, De Lassence Arnaud, Dreyfuss Didier, Ricard Jean-Damien

机构信息

Service de Réanimation Médicale, Hôpital Louis Mourier (Assistance Publique-Hôpitaux de Paris), Colombes, France.

出版信息

Crit Care Med. 2003 Mar;31(3):699-704. doi: 10.1097/01.CCM.0000050443.45863.F5.

Abstract

OBJECTIVE

To determine whether use of a hygroscopic and hydrophobic heat and moisture exchanger (HME) for 7 days without change affects its efficiency in long-term, mechanically ventilated, chronic obstructive pulmonary disease (COPD) patients.

DESIGN

Prospective, randomized, controlled clinical study comparing two combined HMEs.

SETTING

Medical intensive care unit at a university teaching hospital.

PATIENTS

Long-term, mechanically ventilated, COPD patients compared with non-COPD patients.

INTERVENTIONS

In the first part of the study, COPD patients were studied with the Hygroster HME changed once a week. For the second part, the Hygroster was assessed in non-COPD patients and compared with the Hygrobac HME used in COPD and non-COPD patients for 1 wk without change. Devices could be changed if hygrometric measurements indicated insufficient humidity delivery.

MEASUREMENTS AND MAIN RESULTS

Daily measurements were recorded for inspired gas temperature and relative and absolute humidity. Ventilatory variables, clinical indicators of efficient humidification, were also recorded. No tracheal tube occlusion occurred. However, contrary to the manufacturer advertisement, the Hygroster experienced surprisingly low values for absolute humidity in both COPD and non-COPD patients. Such events did not occur with the Hygrobac. Absolute humidity with the Hygroster was constantly and significantly lower during the 7-day study period than with the Hygrobac. Absolute humidity measured in COPD patients was identical to that measured in the rest of the study population with both HMEs.

CONCLUSIONS

Manufacturer specifications and bedside measurements of absolute humidity differed considerably for the Hygroster, which in certain instances did not achieve efficient humidification in both COPD and non-COPD patients. This did not occur with the Hygrobac, which performed well throughout the 7-day period in both COPD and non-COPD patients. Our results speak for independent and evaluation of HMEs.

摘要

目的

确定使用吸湿疏水型热湿交换器(HME)7天不更换是否会影响其在长期机械通气的慢性阻塞性肺疾病(COPD)患者中的效率。

设计

比较两种组合式HME的前瞻性、随机、对照临床研究。

地点

大学教学医院的医学重症监护病房。

患者

长期机械通气的COPD患者与非COPD患者。

干预措施

在研究的第一部分,对COPD患者使用每周更换一次的Hygroster HME进行研究。在第二部分中,对非COPD患者使用Hygroster进行评估,并与在COPD和非COPD患者中使用1周不更换的Hygrobac HME进行比较。如果湿度测量表明湿度输送不足,则可更换设备。

测量指标及主要结果

记录每日吸入气体的温度、相对湿度和绝对湿度。还记录了通气变量,即有效加湿的临床指标。未发生气管导管堵塞。然而,与制造商的广告相反,Hygroster在COPD和非COPD患者中绝对湿度的值出奇地低。Hygrobac未出现这种情况。在为期7天的研究期间,Hygroster的绝对湿度始终显著低于Hygrobac。使用两种HME时,COPD患者测得的绝对湿度与研究人群其他患者测得的相同。

结论

Hygroster的制造商规格与床旁绝对湿度测量值有很大差异,在某些情况下,它在COPD和非COPD患者中均未实现有效加湿。Hygrobac则未出现这种情况,它在COPD和非COPD患者中均在7天内表现良好。我们的结果支持对HME进行独立评估。

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