TY - JOUR
T1 - Short-term effects of humidification devices on respiratory pattern and arterial blood gases during noninvasive ventilation
AU - Lellouche, François
AU - Pignataro, Claudia
AU - Maggiore, Salvatore Maurizio
AU - Girou, Emmanuelle
AU - Deye, Nicolas
AU - Taillé, Solenne
AU - Fischler, Marc
AU - Brochard, Laurent
PY - 2012
Y1 - 2012
N2 - BACKGROUND: The impact of humidification devices on ventilatory and arterial blood gases parameters during noninvasive ventilation (NIV) remains controversial. The aim of the study was to compare the short-term impact of heat and moisture exchangers (HMEs) and heated humidifiers (HHs) during NIV for either hypercapnic or hypoxemic acute respiratory failure.
METHODS: Consecutive subjects receiving NIV were successively treated with HME and HH in randomized order for 30 min each. At the end of each period, arterial blood gases were measured and ventilatory parameters were recorded.
RESULTS: Eighty-one subjects were enrolled, of whom 52 were hypercapnic (with or without acidosis) and 29 hypoxemic. Minute ventilation was greater with the HME, in comparison with the HH (15 [12-18] vs 12 [10-16] median [interquartile range], P < .001), while P(aCO(2)) was increased when using HME, indicating a dead space effect. This effect was observed in all subjects, but was more pronounced in hypercapnic subjects (P(aCO(2)) 62 ± 17 mm Hg with HME vs 57 ± 14 with HH, P < .001). In a subgroup of 19 subjects with respiratory acidosis, alveolar hypoventilation improved only with the HH. The amplitude of the dead space impact was a function of the degree of hypercapnia.
CONCLUSIONS: Use of an HME decreased CO(2) elimination during NIV, despite increased minute ventilation, especially in hypercapnic subjects.
AB - BACKGROUND: The impact of humidification devices on ventilatory and arterial blood gases parameters during noninvasive ventilation (NIV) remains controversial. The aim of the study was to compare the short-term impact of heat and moisture exchangers (HMEs) and heated humidifiers (HHs) during NIV for either hypercapnic or hypoxemic acute respiratory failure.
METHODS: Consecutive subjects receiving NIV were successively treated with HME and HH in randomized order for 30 min each. At the end of each period, arterial blood gases were measured and ventilatory parameters were recorded.
RESULTS: Eighty-one subjects were enrolled, of whom 52 were hypercapnic (with or without acidosis) and 29 hypoxemic. Minute ventilation was greater with the HME, in comparison with the HH (15 [12-18] vs 12 [10-16] median [interquartile range], P < .001), while P(aCO(2)) was increased when using HME, indicating a dead space effect. This effect was observed in all subjects, but was more pronounced in hypercapnic subjects (P(aCO(2)) 62 ± 17 mm Hg with HME vs 57 ± 14 with HH, P < .001). In a subgroup of 19 subjects with respiratory acidosis, alveolar hypoventilation improved only with the HH. The amplitude of the dead space impact was a function of the degree of hypercapnia.
CONCLUSIONS: Use of an HME decreased CO(2) elimination during NIV, despite increased minute ventilation, especially in hypercapnic subjects.
KW - COPD
KW - Noninvasive ventilation
KW - acute respiratory failure
KW - alveolar hypoventilation
KW - dead space
KW - heat and moisture exchangers
KW - heated humidifiers
KW - humidification
KW - COPD
KW - Noninvasive ventilation
KW - acute respiratory failure
KW - alveolar hypoventilation
KW - dead space
KW - heat and moisture exchangers
KW - heated humidifiers
KW - humidification
UR - http://hdl.handle.net/10807/51478
U2 - 10.4187/respcare.01278
DO - 10.4187/respcare.01278
M3 - Article
SN - 0020-1324
VL - 57
SP - 1879
EP - 1886
JO - Respiratory Care
JF - Respiratory Care
ER -