[Heat and moisture exchangers for conditioning of inspired air of intubated patients in intensive care. The humidification properties of passive air exchangers under clinical conditions].

Heat and moisture exchangers (HME) are used as artificial noses for intubated patients to prevent tracheo-bronchial or pulmonary damage resulting from dry and cold inspired gases. HME are mounted directly on the tracheal tube, where they collect a large fraction of the heat and moisture of the expired air, adding this to the subsequent inspired breath. The effective performance depends on the water-retention capacity of the HME: the amount of water added to the inspired gas cannot exceed the stored water uptake of the previous breath. This study evaluates the efficiency of four different HME under laboratory and clinical conditions using a new moisture-measuring device. METHODS. In a first step, the absolute efficiency of four different HME (DAR Hygrobac, Gibeck Humid-Vent 2P, Pall BB 22-15 T, and Pall BB 100) was evaluated using a lung model simulating physiological heat and humidity conditions of the upper airways. The model was ventilated with tidal volumes of 500, 1,000, and 1,500 ml and different flow rates. The water content of the ventilated air was determined between tracheal tube and HME using a new high-resolution humidity meter and compared with the absolute water loss of the exhaled air at the gas outlet of a Siemens Servo C ventilator measured with a dew-point hygrometer. Secondly, the moisturizing efficiency was evaluated under clinical conditions in an intensive care unit with 25 intubated patients. Maintaining the ventilatory conditions for each patient, the HME were randomly changed. The humidity data were determined as described above and compared with the laboratory findings. RESULTS AND DISCUSSION. The water content at the respirator outlet is inversely equivalent to the humidity of the inspired gases and represents the water loss from the respiratory tract if the patient is ventilated with dry gases. Moisture retention and heating capacity decreased with higher volumes and higher flow rates. These data are simple to obtain without affecting the patient and can easily be interpreted. It was demonstrated that, compared to physiological conditions, the DAR Hygrobac and Gibeck Humid Vent 2P-HME coated with hygroscopic salts-were able to maintain sufficient inspiratory humidity and heat. The Pall-HME, solely a condensation humidifier, did not meet the physiological requirements.