Kollef M H, Shapiro S D, Boyd V, Silver P, Von Harz B, Trovillion E, Prentice D
Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
Chest. 1998 Mar;113(3):759-67. doi: 10.1378/chest.113.3.759.
To determine the safety and cost-effectiveness of mechanical ventilation with an extended-use hygroscopic condenser humidifier (Duration; Nellcor Puritan-Bennett; Eden Prairie, Minn) compared with mechanical ventilation with heated-water humidification.
Prospective randomized clinical trial.
Medical and surgical ICUs of Barnes-Jewish Hospital, St. Louis, a university-affiliated teaching hospital.
Three hundred ten consecutive qualified patients undergoing mechanical ventilation.
Patients requiring mechanical ventilation were randomly assigned to receive humidification with either an extended-use hygroscopic condenser humidifier (for up to the first 7 days of mechanical ventilation) or heated-water humidification.
Occurrence of ventilator-associated pneumonia, endotracheal tube occlusion, duration of mechanical ventilation, lengths of intensive care and hospitalization, acquired multiorgan dysfunction, and hospital mortality.
One hundred sixty-three patients were randomly assigned to receive humidification with an extended-use hygroscopic condenser humidifier, and 147 patients were randomly assigned to receive heated-water humidification. The two groups were similar at the time of randomization with regard to demographic characteristics, ICU admission diagnoses, and severity of illness. Risk factors for the development of ventilator-associated pneumonia were also similar during the study period for both treatment groups. Ventilator-associated pneumonia was seen in 15 (9.2%) patients receiving humidification with an extended-use hygroscopic condenser humidifier and in 15 (10.2%) patients receiving heated-water humidification (relative risk, 0.90; 95% confidence interval=0.46 to 1.78; p=0.766). No statistically significant differences for hospital mortality, duration of mechanical ventilation, lengths of stay in the hospital ICU, or acquired organ system derangements were found between the two treatment groups. No episode of endotracheal tube occlusion occurred during the study period in either treatment group. The total cost of providing humidification was $2,605 for patients receiving a hygroscopic condenser humidifier compared with $5,625 for patients receiving heated-water humidification.
Our findings suggest that the initial application of an extended-use hygroscopic condenser humidifier is a safe and more cost-effective method of providing humidification to patients requiring mechanical ventilation compared with heated-water humidification.
确定使用可延长使用时间的吸湿冷凝式加湿器（品牌：Duration；Nellcor Puritan-Bennett；产地：明尼苏达州伊甸草原市）进行机械通气与使用热水加湿器进行机械通气相比的安全性和成本效益。
前瞻性随机临床试验。
圣路易斯市巴恩斯犹太医院的内科和外科重症监护病房，该医院为一所大学附属教学医院。
310例连续接受机械通气的合格患者。
需要机械通气的患者被随机分配接受使用可延长使用时间的吸湿冷凝式加湿器（机械通气的前7天内）或热水加湿器进行加湿。
呼吸机相关性肺炎的发生率、气管内插管阻塞情况、机械通气时间、重症监护和住院时间、获得性多器官功能障碍以及医院死亡率。
163例患者被随机分配接受使用可延长使用时间的吸湿冷凝式加湿器进行加湿，147例患者被随机分配接受热水加湿器进行加湿。两组在随机分组时，在人口统计学特征、重症监护病房入院诊断和疾病严重程度方面相似。在研究期间，两个治疗组发生呼吸机相关性肺炎的危险因素也相似。接受可延长使用时间的吸湿冷凝式加湿器加湿的患者中有15例（9.2%）发生了呼吸机相关性肺炎，接受热水加湿器加湿的患者中有15例（10.2%）发生了呼吸机相关性肺炎（相对危险度，0.90；95%置信区间=0.46至1.78；p=0.766）。两个治疗组在医院死亡率、机械通气时间、在医院重症监护病房的住院时间或获得性器官系统紊乱方面未发现统计学上的显著差异。在研究期间，两个治疗组均未发生气管内插管阻塞事件。接受吸湿冷凝式加湿器加湿的患者的加湿总成本为2605美元，而接受热水加湿器加湿的患者为5625美元。
我们的研究结果表明，与热水加湿相比，最初使用可延长使用时间的吸湿冷凝式加湿器为需要机械通气的患者提供加湿是一种安全且更具成本效益的方法。
