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Humidification During Invasive Mechanical Ventilation: Hygrometric Performances and Cost of Humidification Systems

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Humidification in the Intensive Care Unit

Abstract

The deleterious impact of dry gases on airway mucosa was described very early [1]. Abundant literature on humans and animals is available demonstrating a relationship among airway mucosal dysfunction, inflammation and atelectasis, and (1) the level of gas humidity delivered during invasive mechanical ventilation and (2) the duration of exposure to this gas [2]. An ongoing debate centers on the optimal level of inspiratory gas humidity. Several recommendations have been published on the optimal level of humidification required during invasive mechanical ventilation. Most of these publications are not recent. In general, it is recommended that the humidification systems should provide at least 30 mgH2O/l for inspiratory gases [3–6]. Many studies were published that allow us to better determine what a safe level of humidification is. If we consider as a clinical requirement to avoid obstruction of the endotracheal tube, slightly lower levels of humidity may be sufficient [7]. Few authors recommend using levels of gas humidity corresponding to the water content in the alveoli, or 44 mgH2O/l, which corresponds to 100% relative humidity at 37°C [8]. These latter requirements are not usually obtained with the humidification systems used so far [7, 9]. Until now, no study has really compared stable systems delivering 40 mgH2O/l with stable systems delivering 30 mgH2O/l. In some clinical situations, such as patients ventilated with ARDS or severe asthma, other criteria than the level of humidification should be considered, in particular to take into account the mechanical characteristics of the different humidification systems (especially the dead space). Finally, the issue of the humidification systems’ cost cannot be set aside at the time of the choice.

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  1. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Centre de recherche, Hôpital Laval, 2725, chemin Sainte-Foy, G1V4G5, Québec, QC, Canada

    François Lellouche

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  1. Avenida del Parque 2, 3 B, Murcia, 30500, Spain

    Antonio Matías Esquinas

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Lellouche, F. (2012). Humidification During Invasive Mechanical Ventilation: Hygrometric Performances and Cost of Humidification Systems. In: Esquinas, A. (eds) Humidification in the Intensive Care Unit. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-02974-5_17

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