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Under-humidification and over-humidification during moderate induced hypothermia with usual devices

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Abstract

Objective

In mechanically ventilated patients with induced hypothermia, the efficacy of heat and moisture exchangers and heated humidifiers to adequately humidify the airway is poorly known. The aim of the study was to assess the efficacy of different humidification devices during moderate hypothermia.

Design

Prospective, cross-over randomized study.

Settings

Medical Intensive Care Unit in a University Hospital.

Patients and participants

Nine adult patients hospitalized after cardiac arrest in whom moderate hypothermia was induced (33°C for 24 h).

Interventions

Patients were ventilated at admission (period designated “normothermia”) with a heat and moisture exchanger, and were randomly ventilated during hypothermia with a heat and moisture exchanger, a heated humidifier, and an active heat and moisture exchanger.

Measurements and results

Core temperature, inspired and expired gas absolute and relative humidity were measured. Each system demonstrated limitations in its ability to humidify gases in the specific situation of hypothermia. Performances of heat and moisture exchangers were closely correlated to core temperature (r 2 = 0.84). During hypothermia, heat and moisture exchangers led to major under-humidification, with absolute humidity below 25 mgH2O/l. The active heat and moisture exchanger slightly improved humidification. Heated humidifiers were mostly adequate but led to over-humidification in some patients, with inspiratory absolute humidity higher than maximal water content at 33°C with a positive balance between inspiratory and expiratory water content.

Conclusions

These results suggest that in the case of moderate hypothermia, heat and moisture exchangers should be used cautiously and that heated humidifiers may lead to over-humidification with the currently recommended settings.

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Acknowledgements

The humidification devices were supplied free of charge by manufacturers (Fisher & Paykel and Hudson).

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Authors and Affiliations

  1. Service de Réanimation Médicale, AP-HP, Hôpital Henri Mondor, INSERM U 651, Université PARIS XII, 51 av. du Maréchal de Lattre de Tassigny, 94010, Créteil, France

    François Lellouche, Siham Qader, Solenne Taille, Aissam Lyazidi & Laurent Brochard

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  1. François Lellouche
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  2. Siham Qader
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  3. Solenne Taille
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Correspondence to Laurent Brochard.

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Lellouche, F., Qader, S., Taille, S. et al. Under-humidification and over-humidification during moderate induced hypothermia with usual devices. Intensive Care Med 32, 1014–1021 (2006). https://doi.org/10.1007/s00134-006-0192-8

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  • DOI: https://doi.org/10.1007/s00134-006-0192-8

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