Abstract
Inhaled air is cold and dry. The highly vascularized nasal mucosa warms and humidifies it, and makes it suitable for breathing.
The surface area of the nasal mucosa is enlarged by the three nasal turbinates. As the air is drawn around these, the laminar airflow becomes turbulent. Eddy currents allow better contact of the inspired air with the mucosa and facilitate the transfer of heat and humidity.
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References
Markowicz P, Ricard J-D, Dreyfuss D, et al Safety, efficacy and cost effectiveness of mechanical ventilation with humidifying filters changed every 48 hours: a prospective, randomized study. Crit Care Med 2000;28(3):665-71
Rathgeber J, Henze D, Zuchner K, et al Conditioning of the inspired air with HME’s- an effective and cost saving alternative to heated humidifiers in long-term ventilated patients. A prospective randomized clinical study. Anesthetist 1996;45:518-25
AARC clinical practice guideline. Humidification during mechanical ventilation. American Association for Respiratory Care. Respir Care. 1992;37:887-890
Amirav I, Plit M. Temperature and humidity modify airway response to inhaled histamine in normal subjects. Am Rev Respir Dis. 1989;140:1416-1420
Banner AS, Chausow A, Green J. The tussive effect of hyperpnea with cold air. Am Rev Respir Dis. 1985;131:362-367
Boisson C, Viviand X, Arnaud S, et al Changing a hydrophobic heat and moisture exchanger after 48 hours rather than 24 hours: a clinical and microbiological evaluation. Intensive Care Med. 1999;25:1237-1243
Branson RD, Campbell RS, Davis K, et al Anaesthesia circuits, humidity output, and mucociliary structure and function. Anaesth Intensive Care. 1998;26:178-183
Burton JDK. Effects of dry anesthetic gases on the respiratory mucous membrane. Lancet. 1962;1:235-238
Caldwell PRB, Gomez DM, Fritts HW. Respiratory heat exchange in normal subjects and in patients with pulmonary disease. J Appl Physiol. 1969;26:82-88
Campbell RS, Davis K Jr, Johannigman JA, Branson RD. The effects of passive humidifier dead space on respiratory variables in paralyzedand spontaneously breathing patients. Respir Care. 2000;45:306-312
Chalon J, Loew DAY, Malebranch J. Effects of dry anesthetic gases on tracheobronchial ciliated epithelium. Anesthesiology. 1972;37:338-343
Chiaranda M, Verona L, Pinamonti O, et al Use of heat and moisture exchanging (HME)filters in mechanically ventilated ICU patients: influence on airway flow-resistance. Intensive Care Med. 1993;19:462-466
Christopher KL, Saravolatz LD, Bush TL, Conway WA. The potential role of respiratory therapy equipment in cross infection. A study using a canine model for pneumonia. Am Rev Respir Dis. 1983;128:271-275
Cohen IL, Weinberg PF, Fein IA, Rowinski GS. Endotracheal tube occlusion associated with the use of heat and moisture exchangers in the intensive care unit. Crit Care Med. 1988;16: 277-279
Cole P. Some aspects of temperature, moisture and heat relationship in the upper respiratory tract. J Laryngol Otol. 1953;7:449-456
Comhaire A, Lamy M. Contamination rate of sterilized ventilators in an ICU. Crit Care Med. 1981;9:546-548
Craven DE, Goularte TA, Make BJ. Contaminated condensate in mechanical ventilator circuits. A risk factor for nosocomial pneumonia. Am Rev Respir Dis. 1984;129:625-628
Davis K Jr, Evans SL, Campbell RS, et al Prolonged use of heat and moisture exchangers does not affect device efficiency or frequency rate of nosocomial pneumonia. Crit Care Med. 2000;28:1412-1418
Dery R. The evolution of heat and moisture in the respiratory tract during anaesthesia with non-rebreathing system. Canad Anaesth Soc J. 1973;20:296-309
Dery R. Water balance of the respiratory tract during ventilation with a gas mixture saturated at body temperature. Can Anaesth Soc J. 1973;20:719-727
Dery R, Pelletier J, Jacques A. Humidity in anaesthesiology III: heat and moisture patterns in the respiratory tract during anaesthesia with the semi-closed system. Can Anaesth Soc J. 1967;14:287-294
Déry R, Pelletier J, Jaques A, et al Humidity in anaesthesiology. III. Heat and moisture patterns in the respiratory tract during anaesthesia with the semi-closed system. Can Anaesth Soc J. 1967;14:287-298
Dhand R, Guntur VP. How best to deliver aerosol medications to mechanically ventilated patients. Clin Chest Med. 2008;29(2):277-296
Djedaini K, Billiard M, Mier L, et al Changing heat and moisture exchangers every 48 hours rather than 24 hours does not affect their efficacy and incidence of nosocomial pneumonia. Am J Respir Crit Care Med. 1995;152:1562-1569
Fonkalsrud EW, Calmes S, Barcliff LT, et al Reduction of operative heat loss and pulmonary secretions in neonates by use of heated and humidified anesthetic gases. J Thorac Cardiovasc Surg. 1980;80:718-723
Girault C, Breton L, Richard J, et al Effects of airway humidification devices during difficult weaning from mechanical ventilation. Am J Respir Crit Care Med. 2000;161:A560
Hirsch JA, Tokayer JL, Robinson MJ, et al Effects of dry air and subsequent humidification on tracheal mucus velocity in dogs. J Appl Physiol. 1975;39:242-246
Ingelstedt S. Studies of the conditioning of air in the respiratory tract. Acta Otolaryngol. 1956;131:1-81
Iotti GA, Olivei MC, Palo A, et al Unfavorable mechanical effects of heat and moisture exchangers in ventilated patients. Intensive Care Med. 1997;23(4):399-405
Kirton O, DeHaven B, Morgan J, Civetta J. A prospective, randomized comparison of an in-line heat and moisture exchange filter and heated wire humidifiers: rates of ventilatior-associated early-onset (community-acquired) or late - onset (hospital-acquired) pneumonia and incidence of endotracheal tube occlusion. Chest. 1998;112:1055-1059
Kleemann PP. The climatisation of anesthetic gases under conditions of high flow to low flow. Acta Anaesthesiol Belg. 1990;41:189-200
Kleemann PP. Humidity of anaesthetic gases with respect to low flow anaesthesia. Anaesth Intensive Care. 1994;22:396-408
Klein EF, Graves SA. “Hot pot” tracheitis. Chest. 1974;65:225-226
Kollef M, Shapiro S, Boyd V, et al A randomized clinical trial comparing an extended-use hygroscopic condenser humidifier with heated -water humidification in mechanically ventilated patients. Chest. 1998;113:759-767
Lellouche F, Maggiore SM, Deye N, et al Effect of the humidification device on the work of breathing during noninvasive ventilation. Intensive Care Med. 2002;28:1582-1589
Lichtiger M, Landa JF, Hirsch JA. Velocity of tracheal mucus in anesthetized women undergoing gynaecologic surgery. Anesthesiology. 1975;42:413-419
Marfatia S, Donahoe PK, Hendren WH. Effects of dry and humidified gases on the respiratory epithelium in rabbits. J Paediatr Surg. 1975;10:583-592
McFadden ER. Heat and water exchange in human airways. Am Rev Respir Dis. 1992;146:S8-S10
McFadden ER, Pichurko BM, Bowman HF, et al Thermal mapping of the airways in humans. J Appl Physiol. 1985;58:564-570
Misset B, Escudier B, Rivara D, et al Heat and moisture exchanger vs heated humidifier during long-term mechanical ventilation: a prospective randomized study. Chest. 1991;100:160-163
Modell JH, Giammona ST, Davis JH. Effect of chronic exposure to ultrasonic aerosols in the lung. Anesthesiology. 1967;28:680-684
Radenrath WJ, Meier J, Genger H, et al Efficiency of cold passover and heated humidification under continuous positive airway pressure. Eur Respir J. 2002;19:1-4
Rashad K, Wilson K, Hurt HH, et al Effect of humidification of anesthetic gases on static compliance. Anesth Analg Curr Res. 1967;46:127-133
Rathgeber J. Devices used to humidify respired gases. Respir Care Clin. 2006;12:165-183
Rathgeber J, Zuchner K, Burchardi H. Conditioning of the air in mechanically ventilated patients. In: Vincent JL, ed. Yearbook of Intensive Care and Emergency Medicine. Berlin: Springer; 1996:155-164
Rathgeber J, Kazmaier S, Penack O, et al Evaluation of heated humidifiers for use on intubated patients. A comparative study of humidifying efficiency, flow resistance and alarm functions using a lung model. Intensive Care Med. 2002;28:731-739
Ricard J-D, Le Miere E, Markowicz P, et al Efficiency and safety of mechanical ventilation with a heat and moisture exchanger changed only once a week. Am J Respir Crit Care Med. 2000;161:104-109
Ricard J-D, Hidri N, Blivet A, et al New heated breathing cirtcuits do not prevent condensation and contamination of ventilator circuits with heated humidifiers. Am J Respir Crit Care Med. 2003;167:A861
Ricard J-D, Boyer A, Dreyfuss D. The effect of humidification on the incidence of ventilator-associated pneumonia. Respir Care Clin. 2006;12:263-273
Roustan JP, Kienlen J, Aubas P, Aubas S, du Cailar J. Compairson of hydrophobic heat and moistureexchangers with heated humidifier during prolonged mechanical ventilation. Intensive Care Med. 1992;18:97-100
Ryan SN, Rankin N, Meyer E, et al Energy balance in the intubated human airway is an indicator of optimal gas conditioning. Crit Care Med. 2002;30:355-361
Sackner MA, Rosen MJ, Wanner A. Estimation of tracheal mucus velocity by bronchofibroscopy. J Appl Physiol. 1973;34:495-499
Shelley MP. The humidification and filtration functions of the airway. Respir Care Clin. 2006;12:139-148
Sottiaux TM. Consequences of under- and over-humidification. Respir Care Clin N Am. 2006;12(2):233-252
Theissen RJ. Filtration of respired gases: theoretical aspects. Respir Care Clin. 2006;12:183-201
Thiery G, Boyer A, Pigne E, et al Heat and moisture exchangers in mechanical ventilated intensive care unit patients: aplea for an independent assessment of their performance. Crit Care Med. 2003;31:699-704
Thomachot L, Vialet R, Arnaud S, et al Do the components of heat and moisture exchanger filters affect their humidifying efficacy and the incidence of nosocomial pneumonia ? Crit Care Med. 1999;27:923-928
Thomachot L, Leone M, Razzouk K, et al Randomized clinical trial of extended use of a hydrophobic condenser humidifier: 1 vs. 7 days. Crit Care Med. 2002;30:232-237
Todd DA, John E, Osborn RA. Tracheal damage following conventional and high-frequency ventilation at low and high humidity. Crit Care Med. 1991;19:1310-1316
Wanner A. Clinical aspects of mucociliary clearance. Am Rev Respir Dis. 1977;116:73-125
Williams RB. The effects of excessive humidity. Respir Care Clin N Am. 1998;4:215-226
Williams RB, Rankin N, Smith T, et al Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa. Crit Care Med. 1996;24:1920-1929
Zuchner K. Humidification: measurements and requirements. Respir Care Clin. 2006;12:149-163
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Hasan, A. (2010). Airway Humidification in the Mechanically Ventilated Patient. In: Understanding Mechanical Ventilation. Springer, London. https://doi.org/10.1007/978-1-84882-869-8_15
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DOI: https://doi.org/10.1007/978-1-84882-869-8_15
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