Evaluation of Resistance in 8 Different Heat-and-Moisture Exchangers: Effects of Saturation and Flow Rate/Profile

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Abstract:

INTRODUCTION: When endotracheal intubation is required during ventilatory support, the physiologic mechanisms of heating and humidifying the inspired air related to the upper airways are bypassed. The task of conditioning the air can be partially accomplished by heat-and-moisture exchangers (HMEs). OBJECTIVES: To evaluate and compare with respect to imposed resistance, different types/models of HME: (1) dry versus saturated, (2) changing inspiratory flow rates. MATERIALS AND METHODS: Eight different HMEs were studied using a lung model system. The study was conducted initially by simulating spontaneous breathing, followed by connecting the system directly to a mechanical ventilator to provide pressure-support ventilation. RESULTS: None of the encountered values of resistance (0.5–3.6 cm H2O/L/s) exceeded the limits stipulated by the previously described international standard for HMEs (International Standards Organization Draft International Standard 9360-2) (not to exceed 5.0 cm H2O with a flow of 1.0 L/s, even when saturated). The hygroscopic HME had less resistance than other types, independent of the precondition status (dry or saturated) or the respiratory mode. The hygroscopic HME also had a lesser increase in resistance when saturated. The resistance of the HME was little affected by increases in flow, but saturation did increase resistance in the hydrophobic and hygroscopic/hydrophobic HME to levels that could be important at some clinical conditions. CONCLUSIONS: Resistance was little affected by saturation in hygroscopic models, when compared to the hydrophobic or hygroscopic/hydrophobic HME. Changes in inspiratory flow did not cause relevant alterations in resistance.

Keywords: HEAT-AND-MOISTURE EXCHANGERS; MECHANICAL VENTILATION; RESISTANCE; RESPIRATORY MECHANICS

Document Type: Research Article

Affiliations: 1: Pulmonary Division, Respiratory Intensive Care Unit, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil, Rua Professor Pedreira de Freitas, 372 - Apt 101E, CEP 03312–052, Sao Paulo, Brazil;, Email: jeanettejaber@yahoo.com 2: Pulmonary Division, Respiratory Intensive Care Unit, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil 3: Regions Hospital, St Paul, Minnesota

Publication date: May 1, 2005

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