Skip to main content

Humidification in Noninvasive Mechanical Ventilation and High-Flow Oxygen

  • Chapter
  • First Online:
Upper Airway Disorders and Noninvasive Mechanical Ventilation

Abstract

The human airways have an important role in heating and humidifying inspired gas and recovering heat and moisture from expired gas.

When there is respiratory failure resulting in hypoxemia (type I respiratory failure) and, sometimes, hypercapnia (type II respiratory failure), the available therapies are represented by oxygen therapy and mechanical ventilation.

Oxygen supplementation often takes the form of a low-flow nasal cannula (LFNC); however, there are limitations to this supplemental oxygen intervention. A traditional nasal cannula can effectively provide only up to 4–6 L per minute of supplemental oxygen.

The efficacy of LFNC is limited, because of nasal mucosal irritation, there is an increased potential for bleeding with prolonged use, and also there are high levels of leaking air around the oxygen source.

High-flow nasal cannula (HFNC) therapy is an oxygen supply system carried out through dedicated devices or through mechanical ventilation, and it is capable of delivering up to 100% humidified and heated oxygen.

Noninvasive ventilation (NIV) is usually delivered through a nasal or oronasal mask. Like during spontaneous breathing, patients under NIV require adequate humidification and heating of the inspired air.

Two types of devices for conditioning inspired gases in the presence or absence of an artificial airway are available: heat and moisture exchangers (HME) and active humidifiers.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Plotnikow GA, Accoce M, Navarro E, Tiribelli N. Humidification and heating of inhaled gas in patients with artificial airway. A narrative review. Rev Bras Ter Intensiva. 2018;30(1):86–97.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Plicher J, Beasley R. Acute use of oxygen therapy. Aust Prescr. 2015;38:98–100.

    Article  Google Scholar 

  3. Lodeserto FJ, Lettich TM, Rezaie SR. High-flow nasal cannula: mechanisms of action and adult and pediatric indications. Cureus. 2018;10(11):e3639. https://doi.org/10.7759/cureus.3639.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gajic O, et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med. 2004;32:1817–24.

    Article  PubMed  Google Scholar 

  5. Investigators ART. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome. JAMA. 2017;318(14):1335–45.

    Article  Google Scholar 

  6. Nava S, Fanfulla F. Ventilazione meccanica non invasiva. Come, quando e perché. Springer-Verlag Italia SRL; 2010.

    Book  Google Scholar 

  7. Lindemann J, Leiacker R, Rettinger G, Keck T. Nasal mucosal temperature during respiration. Clin Otolaryngol Allied Sci. 2002;27(3):135–9.

    Article  CAS  PubMed  Google Scholar 

  8. Esquinas Rodriguez AM, Scala R, Soroksky A, BaHammam A, de Klerk A, Valipour A, Chiumello D, Martin C, A.E. Holland clinical review: humidifiers during non-invasive ventilation - key topics and practical implications. Crit Care. 2012;16:203.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Richards GN, Cistulli PA, Ungar RG, Berthon-Jones M, Sullivan CE. Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance. Am J Respir Crit Care Med. 1996;154:182–6.

    Article  CAS  PubMed  Google Scholar 

  10. Tuggeya JM, Delmastrob M, Elliott MW. The effect of mouth leak and humidification during nasal non-invasive ventilation. Respir Med. 2007;101:1874–9.

    Article  Google Scholar 

  11. Restrepo RD, Walsh BK. Humidification During Invasive and Noninvasive Mechanical Ventilation. Respir Care. 2012;57(5):782–8.

    Article  PubMed  Google Scholar 

  12. De Araujo M, Vieira SB, Vasquez EC, Fleury B. Heated humidification or face mask to prevent upper airway dryness during continuous positive airway pressure therapy. Chest. 2000;117(1):142–7.

    Article  Google Scholar 

  13. Chanques G, Constantin J, Sauter M, Jung B, Sebbane M, Verzilli D, Lefrant J, S. Jaber S. Discomfort associated with under humidified high flow oxygen therapy in critically ill patients. Intensive Care Med. 2009;35(6):996–1003.

    Article  CAS  PubMed  Google Scholar 

  14. Sztrymf B, Messika J, Bertrand F, Hurel D, Leon R, Dreyfuss D, Ricard JD. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med. 2011;37(11):1780–6.

    Article  CAS  PubMed  Google Scholar 

  15. Rochwerg B, Granton D, Wang DX, Helviz Y, Einav S, Frat JP, Mekontso-Dessap A, Schreiber A, Azoulay E, Mercat A, Demoule A, Lemiale V, Pesenti A, Riviello ED, Mauri T, Mancebo J, Brochard L, Burns K. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med. 2019;45(5):563–72.

    CAS  PubMed  Google Scholar 

  16. Goteraa C, Díaz Lobatoa S, Pinto T, Winck JC. Clinical evidence on high flow oxygen therapy and active humidification in adults. Rev Port Pneumol. 2013;19(5):217–27.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Elvia Giovanna Battaglia .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Battaglia, E.G., Roma, E. (2023). Humidification in Noninvasive Mechanical Ventilation and High-Flow Oxygen. In: Esquinas, A.M., De Vito, A., Barbetakis, N. (eds) Upper Airway Disorders and Noninvasive Mechanical Ventilation. Springer, Cham. https://doi.org/10.1007/978-3-031-32487-1_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-32487-1_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-32486-4

  • Online ISBN: 978-3-031-32487-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics