Advertisement

Intensive Care Medicine

, Volume 35, Issue 6, pp 996–1003 | Cite as

Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients

  • Gerald ChanquesEmail author
  • Jean-Michel Constantin
  • Magali Sauter
  • Boris Jung
  • Mustapha Sebbane
  • Daniel Verzilli
  • Jean-Yves Lefrant
  • Samir Jaber
Original

Abstract

Objective

To measure (1) the discomfort in non-intubated patients under high-flow oxygen therapy (HFOT) humidified with bubble (BH) or heated humidifiers (HH), and (2) the hygrometric properties of oxygen with a BH and an HH.

Design and setting

This was a randomized cross-over study in critically ill patients during a 3-day period. The humidification device used at days 1 and 3 was changed for the other at day 2. (2) It was also an experimental bench study using the psychrometric method with five randomized flows (3, 6, 9, 12 and 15 l/min) and different humidification techniques.

Methods

Discomfort, particularly dryness of the mouth and throat, was measured for two humidification conditions (BH and HH) using a 0–10 numerical rating scale (NRS) by patients requiring HFOT with a face mask at a flow ≥5 l/min, in a double-blinded condition.

Results

(1) In this clinical study, 30 patients treated by HFOT at a median flow of 7.8 l/min (5.1–10.9) were included. The global incidence of moderate (NRS = 4–6) and severe discomfort (NRS = 7–10) was 25 and 29%, respectively. The median intensities of both mouth and throat dryness were significantly lower with the HH than with the BH [7.8 (5.0–9.4) vs. 5.0 (3.1–7.0), = 0.001 and 5.8 (2.3–8.5) vs. 4.3 (2.0–5.0), = 0.005, respectively]. (2) In the bench study, the mean absolute humidity measured at an ambient temperature of 26°C with the HH was two times greater than with the BH (30 ± 1 vs. 16 ± 2 mg/l, P < 0.05) regardless of the flow rate.

Conclusions

Compared to bubble humidifiers, the use of a heated-humidifier in patients with high-flow oxygen therapy is associated with a decrease of dryness symptoms mediated by increased humidity delivered to the patient.

Keywords

Respiratory insufficiency Oxygen inhalation therapy Mouth dryness Pain Intensive care equipment and supplies 

Notes

Acknowledgments

This research has been presented in part at the 35th Congress of the French Society of Intensive Care (SRLF), Paris, 2007. We thank all the residents and nurses who have participated in the clinical study. We thank Mr. Patrick McSweeny, Richard Degas (Fisher & Paykel Healthcare France, Courtaboeuf, France) and Jérôme Pigeot (Respironics France, Carquefou, France), biomedical engineers, for their scientific contribution, particularly for the bench test study.

Supplementary material

134_2009_1456_MOESM1_ESM.doc (112 kb)
Electronic supplementary material 1 (DOC 112 kb)

References

  1. 1.
    Mithoefer JC, Karetzky MS, Mead GD (1967) Oxygen therapy in respiratory failure. N Engl J Med 277:947–949PubMedCrossRefGoogle Scholar
  2. 2.
    Maroko PR, Radvany P, Braunwald E, Hale SL (1975) Reduction of infarct size by oxygen inhalation following acute coronary occlusion. Circulation 52:360–368PubMedGoogle Scholar
  3. 3.
    Kallstrom TJ, American Association for Respiratory C (2002) AARC Clinical Practice Guideline: oxygen therapy for adults in the acute care facility—2002 revision & update. Respir Care 47:717–720PubMedGoogle Scholar
  4. 4.
    Novaes M, Knobel E, Bork A, Pavão O, Nogueira-Martins L, Ferraz M (1999) Stressors in ICU: perception of the patient, relatives and health care team. Intensive Care Med 25:1421–1426PubMedCrossRefGoogle Scholar
  5. 5.
    Payen JF, Chanques G, Mantz J, Hercule C, Auriant I, Leguillou JL, Binhas M, Genty C, Rolland C, Bosson JL, Investigators ftD (2007) Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology 106:687–695PubMedCrossRefGoogle Scholar
  6. 6.
    Chanques G, Sebbane M, Barbotte E, Viel E, Eledjam JJ, Jaber S (2007) A prospective study of pain at rest: incidence and characteristics of an unrecognized symptom in surgical and trauma versus medical intensive care unit patients. Anesthesiology 107:858–859PubMedCrossRefGoogle Scholar
  7. 7.
    Puntillo K, Morris A, Thompson C, Stanik-Hutt J, White C, Wild L (2004) Pain behaviors observed during six common procedures: results from Thunder Project II. Crit Care Med 32:421–427PubMedCrossRefGoogle Scholar
  8. 8.
    Salah B, Dinh Xuan AT, Fouilladieu JL, Lockhart A, Regnard J (1988) Nasal mucociliary transport in healthy subjects is slower when breathing dry air. Eur Respir J 1:852–855PubMedGoogle Scholar
  9. 9.
    Fontanari P, Burnet H, Zattara-Hartmann MC, Jammes Y (1996) Changes in airway resistance induced by nasal inhalation of cold dry, dry, or moist air in normal individuals. J Appl Physiol 81:1739–1743PubMedGoogle Scholar
  10. 10.
    Estey W (1980) Subjective effects of dry versus humidified low flow oxygen. Respir Care 25:1143–1144Google Scholar
  11. 11.
    Campbell EJ, Baker MD, Crites-Silver P (1988) Subjective effects of humidification of oxygen for delivery by nasal cannula. A prospective study. Chest 93:289–293PubMedCrossRefGoogle Scholar
  12. 12.
    Andres D, Thurston N, Brant R, Flemons W, Fofonoff D, Ruttimann A, Sveinson S, Neil C (1997) Randomized double-blind trial of the effects of humidified compared with nonhumidified low flow oxygen therapy on the symptoms of patients. Can Respir J 4:76–80Google Scholar
  13. 13.
    Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710PubMedCrossRefGoogle Scholar
  14. 14.
    Roussel C, Massion P (2003) Méthode d’Evaluation de la Confusion en Unité de Soins Intensifs. CAM-ICU. Available via http://www.icudelirium.org/delirium/training-pages/French.pdf. Accessed 2006
  15. 15.
    Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR (2003) Monitoring sedation status over time in ICU patients: reliability and validity of the richmond agitation-sedation scale (RASS). JAMA 289:2983–2991PubMedCrossRefGoogle Scholar
  16. 16.
    Chanques G, Jaber S, Barbotte E, Verdier R, Henriette K, Lefrant J, Eledjam J (2006) Validation of the french translated Richmond vigilance-agitation scale. Ann Fr Anesth Reanim 25:696–701PubMedGoogle Scholar
  17. 17.
    Gagliese L, Weizblit N, Ellis W, Chan V (2005) The measurement of postoperative pain: a comparison of intensity scales in younger and older surgical patients. Pain 117:412–420PubMedCrossRefGoogle Scholar
  18. 18.
    Chanques G, Jaber S, Barbotte E, Violet S, Sebbane M, Perrigault P, Mann C, Lefrant J, Eledjam J (2006) Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 34:1691–1699PubMedCrossRefGoogle Scholar
  19. 19.
    Thiéry G, Boyer A, Pigné E, Salah A, De Lassence A, Dreyfuss D, Ricard J (2003) Heat and moisture exchangers in mechanically ventilated intensive care unit patients: a plea for an independent assessment of their performance. Crit Care Med 31:699–704PubMedCrossRefGoogle Scholar
  20. 20.
    Chiumello D, Pelosi P, Park G, Candiani A, Bottino N, Storelli E, Severgnini P, D’Onofrio D, Gattinoni L, Chiaranda M (2004) In vitro and in vivo evaluation of a new active heat moisture exchanger. Crit Care 8:R281–R288PubMedCrossRefGoogle Scholar
  21. 21.
    Ricard J, Markowicz P, Djedaini K, Mier L, Coste F, Dreyfuss D (1999) Bedside evaluation of efficient airway humidification during mechanical ventilation of the critically ill. Chest 115:1646–1652PubMedCrossRefGoogle Scholar
  22. 22.
    Desbiens NA, Wu AW, Alzola C, Mueller-Rizner N, Wenger NS, Connors AF, Lynn J, Phillips RS (1997) Pain during hospitalization is associated with continued pain six months later in survivors of serious illness. The SUPPORT Investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. Am J Med 102:269–276PubMedCrossRefGoogle Scholar
  23. 23.
    Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Meier M, Preuss U, Bullinger M, Schüffel W, Peter K (1998) Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 26:651–659PubMedCrossRefGoogle Scholar
  24. 24.
    Jones C, Griffiths RD, Humphris G, Skirrow PM (2001) Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 29:573–580PubMedCrossRefGoogle Scholar
  25. 25.
    Williams R, Rankin N, Smith T, Galler D, Seakins P (1996) Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa. Crit Care Med 24:1920–1929PubMedCrossRefGoogle Scholar
  26. 26.
    Jaber S, Chanques G, Matecki S, Ramonatxo M, Souche B, Perrigault PF, Eledjam JJ (2002) Comparison of the effects of heat and moisture exchangers and heated humidifiers on ventilation and gas exchange during non-invasive ventilation. Intensive Care Med 28:1590–1594PubMedCrossRefGoogle Scholar
  27. 27.
    Lellouche F, Maggiore SM, Deye N, Taillé S, Pigeot J, Harf A, Brochard L (2002) Effect of the humidification device on the work of breathing during noninvasive ventilation. Intensive Care Med 28:1582–1589PubMedCrossRefGoogle Scholar
  28. 28.
    Brownson K (2000) Hospital air is sick. Hosp Mater Manage Q 22:1–8PubMedGoogle Scholar
  29. 29.
    Hellgren UM, Reijula K (2006) Indoor-air-related complaints and symptoms among hospital workers. Scand J Work Environ Health Suppl 2:47–49Google Scholar
  30. 30.
    Lellouche F, Qader S, Taille S, Aboab J, Thille A, Boussignac G, Brochard L (2004) Hygrometric measurements during CPAP with Boussignac CPAP and different humidification strategy in healthy subjects. Am J Respir Crit Care Med A254Google Scholar
  31. 31.
    Darin J, Broadwell J, MacDonell R (1982) An evaluation of water-vapor output from four brands of unheated, prefilled bubble humidifiers. Respir Care 27:41–50PubMedGoogle Scholar
  32. 32.
    Hamill-Ruth RJ, Marohn ML (1999) Evaluation of pain in the critically ill patient. Crit Care Clin 15:35–54PubMedCrossRefGoogle Scholar
  33. 33.
    Puntillo KA, White C, Morris AB, Perdue ST, Stanik-Hutt J, Thompson CL, Wild LR (2001) Patients’ perceptions and responses to procedural pain: results from Thunder Project II. Am J Crit Care 10:238–251PubMedGoogle Scholar
  34. 34.
    Le Gall J, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRefGoogle Scholar
  35. 35.
    Vincent J, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter P, Sprung C, Colardyn F, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 26:1793–1800PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Gerald Chanques
    • 1
    • 3
    Email author
  • Jean-Michel Constantin
    • 1
  • Magali Sauter
    • 1
  • Boris Jung
    • 1
  • Mustapha Sebbane
    • 1
  • Daniel Verzilli
    • 1
  • Jean-Yves Lefrant
    • 2
  • Samir Jaber
    • 1
  1. 1.Intensive Care and Anesthesiology Department “B” (SAR B)Saint Eloi Hospital. Montpellier University HospitalMontpellier Cedex 5France
  2. 2.Intensive Care and Anesthesiology DepartmentCarémeau Hospital, Nîmes University HospitalNîmes Cedex 9France
  3. 3.Service d’Anesthésie et de Réanimation “B” (SAR B)HOPITAL SAINT ELOI, CHU de MontpellierMontpellier Cedex 5France

Personalised recommendations