Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients
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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.
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.
(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), P = 0.001 and 5.8 (2.3–8.5) vs. 4.3 (2.0–5.0), P = 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.
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.
KeywordsRespiratory insufficiency Oxygen inhalation therapy Mouth dryness Pain Intensive care equipment and supplies
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.
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