Log in | Register

Impact of the humidification device on intubation rate during noninvasive ventilation with ICU ventilators: results of a multicenter randomized controlled trial

François Lellouche| E. L’Her| F. Abroug| N. Deye| P. O. Rodriguez| A. Rabbat| S. Jaber| M. Fartoukh| G. Conti| C. Cracco| J. C. Richard| J. D. Ricard| H. Mal| H. Mentec| F. Loisel| J. C. Lacherade| S. Taillé| L. Brochard
Original
Volume 40, Issue 2 / February , 2014

Pages 211 - 219

Abstract

Purpose

The use of heat and moisture exchangers (HME) during noninvasive ventilation (NIV) can increase the work of breathing, decrease alveolar ventilation, and deliver less humidity in comparison with heated humidifiers (HH). We tested the hypothesis that the use of HH during NIV with ICU ventilators for patients with acute respiratory failure would decrease the rate of intubation (primary endpoint) as compared with HME.

Methods

We conducted a multicenter randomized controlled study in 15 centers. After stratification by center and type of respiratory failure (hypoxemic or hypercapnic), eligible patients were randomized to receive NIV with HH or HME.

Results

Of the 247 patients included, 128 patients were allocated to the HME group and 119 to the HH group. Patients were comparable at baseline. The intubation rate was not significantly different: 29.7 % in the HME group and 36.9 % in the HH group (p = 0.28). PaCO2 did not significantly differ between the two arms, even in the subgroup of hypercapnic patients. No significant difference was observed for NIV duration, ICU and hospital LOS, or ICU mortality (HME 14.1 vs. HH 21.5 %, p = 0.18).

Conclusions

In this study, the short-term physiological benefits of HH in comparison with HME during NIV with ICU ventilators were not observed, and no difference in intubation rate was found. The physiologic effects may have been obscured by leaks or other important factors in the clinical settings. This study does not support the recent recommendation favoring the use of HH during NIV with ICU ventilators.

Keywords

References

  1. American Association for Respiratory Care, Restrepo RD, Walsh BK (2012) Humidification during invasive and noninvasive mechanical ventilation. Respir Care 57:782–788
    • View reference on PubMed
    • View reference on publisher's website
  2. Nava S, Navalesi P, Gregoretti C (2009) Interfaces and humidification for noninvasive mechanical ventilation. Respir Care 54:71–84
    • View reference on PubMed
  3. Primiano FP Jr, Montague FW Jr, Saidel GM (1984) Measurement system for respiratory water vapor and temperature dynamics. J Appl Physiol 56:1679–1685
    • View reference on PubMed
  4. Sara C, Currie T (1965) Humidification by nebulization. Med J Aust 191:174–179
  5. Hill NS (1997) Complications of noninvasive positive pressure ventilation. Respir Care 42:432–442
  6. Mehta S, Hill NS (2001) Noninvasive ventilation. Am J Respir Crit Care Med 163:540–577
    • View reference on PubMed
    • View reference on publisher's website
  7. Carlucci A, Richard JC, Wysocki M, Lepage E, Brochard L (2001) Noninvasive versus conventional mechanical ventilation. An epidemiologic survey. Am J Respir Crit Care Med 163:874–880
    • View reference on PubMed
    • View reference on publisher's website
  8. Demoule A, Girou E, Richard JC, Taille S, Brochard L (2006) Increased use of noninvasive ventilation in French intensive care units. Intensive Care Med 32:1747–1755
  9. Cabanes LR, Weber SN, Matran R, Regnard J, Richard MO, Degeorges ME, Lockhart A (1989) Bronchial hyper-responsiveness to methacholine in patients with impaired left ventricular function. N Engl J Med 320:1317–1322
    • View reference on PubMed
    • View reference on publisher's website
  10. Hospers JJ, Postma DS, Rijcken B, Weiss ST, Schouten JP (2000) Histamine airway hyper-responsiveness and mortality from chronic obstructive pulmonary disease: a cohort study. Lancet 356:1313–1317
    • View reference on PubMed
    • View reference on publisher's website
  11. 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 81:1739–1743
    • View reference on PubMed
  12. Lellouche F, Maggiore SM, Lyazidi A, Deye N, Taille S, Brochard L (2009) Water content of delivered gases during non-invasive ventilation in healthy subjects. Intensive Care Med 35:987–995
  13. Lellouche F, Pignataro C, Maggiore SM, Girou E, Deye N, Taille S, Fischler M, Brochard L (2012) Short-term effects of humidification devices on respiratory pattern and arterial blood gases during noninvasive ventilation. Respir Care 57:1879–1886
    • View reference on PubMed
    • View reference on publisher's website
  14. 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 28:1590–1594
  15. Lellouche F, Maggiore SM, Deye N, Taille S, Pigeot J, Harf A, Brochard L (2002) Effect of the humidification device on the work of breathing during noninvasive ventilation. Intensive Care Med 28:1582–1589
  16. Ambrosino N, Foglio K, Rubini F, Clini E, Nava S, Vitacca M (1995) Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success. Thorax 50:755–757
    • View reference on PubMed
    • View reference on publisher's website
  17. Anton A, Guell R, Gomez J, Serrano J, Castellano A, Carrasco JL, Sanchis J (2000) Predicting the result of noninvasive ventilation in severe acute exacerbations of patients with chronic airflow limitation. Chest 117:828–833
    • View reference on PubMed
    • View reference on publisher's website
  18. Poponick JM, Renston JP, Bennett RP, Emerman CL (1999) Use of a ventilatory support system (BiPAP) for acute respiratory failure in the emergency department. Chest 116:166–171
    • View reference on PubMed
    • View reference on publisher's website
  19. Putinati S, Ballerin L, Piattella M, Panella GL, Potena A (2000) Is it possible to predict the success of non-invasive positive pressure ventilation in acute respiratory failure due to COPD? Respir Med 94:997–1001
    • View reference on PubMed
    • View reference on publisher's website
  20. Soo Hoo GW, Santiago S, Williams AJ (1994) Nasal mechanical ventilation for hypercapnic respiratory failure in chronic obstructive pulmonary disease: determinants of success and failure. Crit Care Med 22:1253–1261
    • View reference on PubMed
    • View reference on publisher's website
  21. Lellouche F, L’Her E, Abrouk F, Deye N, Rabbat A, Jaber S, Fartoukh M, Conti G, Cracco C, Ricard JD, Mal H, Mentec H, Loisel F, Lacherade JC, Rodriguez P, Brochard L (2006) Impact of the humidification device on intubation rate during NIV: results of a multicenter RCT. Am J Respir Crit Care Med 3:A471
  22. Le Gal YM, Fabre J, Barthelemy R, Vanleeuw P, Lagente M, Puel P (1994) Evaluation of a cardiopulmonary preservation method for heart–lung transplantation. Acta Biomed Ateneo Parmense 65:213–224
    • View reference on PubMed
  23. Lellouche F, Taille S, Lefrancois F, Deye N, Maggiore SM, Jouvet P, Ricard JD, Fumagalli B, Brochard L (2009) Humidification performance of 48 passive airway humidifiers: comparison with manufacturer data. Chest 135:276–286
    • View reference on PubMed
    • View reference on publisher's website
  24. Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, Simonneau G, Benito S, Gasparetto A, Lemaire F et al (1995) Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 333:817–822
    • View reference on PubMed
    • View reference on publisher's website
  25. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
    • View reference on PubMed
    • View reference on publisher's website
  26. Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D (1996) The logistic organ dysfunction system. A new way to assess organ dysfunction in the intensive care unit ICU scoring group. JAMA 276:802–810
    • View reference on PubMed
    • View reference on publisher's website
  27. McCabe WR, Jackson GG (1962) Gram-negative bacteriemia: I. Etiology and ecology. Arch Intern Med 110:847–855
    • View reference on publisher's website
  28. Diaz O, Iglesia R, Ferrer M, Zavala E, Santos C, Wagner PD, Roca J, Rodriguez-Roisin R (1997) Effects of noninvasive ventilation on pulmonary gas exchange and hemodynamics during acute hypercapnic exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 156:1840–1845
    • View reference on PubMed
    • View reference on publisher's website
  29. Lellouche L, Taillé S, Maggiore SM, Qader S, L’Her E, Deye N, Brochard L (2004) Influence of ambient air and ventilator output temperature on performances of heated-wire humidifiers. Am J Respir Crit Care Med 170:1073–1079
    • View reference on PubMed
    • View reference on publisher's website
  30. Boyer A, Vargas F, Hilbert G, Gruson D, Mousset-Hovaere M, Castaing Y, Dreyfuss D, Ricard JD (2010) Small dead space heat and moisture exchangers do not impede gas exchange during noninvasive ventilation: a comparison with a heated humidifier. Intensive Care Med 36:1348–1354
  31. Branson RD, Gentile MA (2010) Is humidification always necessary during noninvasive ventilation in the hospital? Respir Care 55:209–216
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement