OBJECTIVE: To evaluate the effects of the humidification device on respiratory, hemodynamic and gas exchange parameters in acute respiratory distress syndrome (ARDS) patients. DESIGN: A prospective open study. SETTING: A medical intensive care unit of a university hospital. PATIENTS: Acute respiratory distress syndrome patients, with hypercapnia (PaCO(2)>60 mmHg). INTERVENTION: A progressive reduction of the humidification system dead space (DSh). The following five conditions were tested sequentially: (1). heat and moisture exchanger (internal volume=95 ml) with a tracheal closed-suction system (internal volume=25 ml; total DSh=120 ml), (2). heat and moisture exchanger (internal volume=45 ml) with the closed-suction system (DSh=70 ml), (3). heat and moisture exchanger (internal volume=25 ml) with the closed-suction system (DSh=50 ml), (4). heated humidifier with the closed-suction system (DSh=25 ml) and (5). heated humidifier alone (DSh=0 ml). Recordings were performed at baseline and every 30 min after each artificial dead-space reduction. All ventilatory settings remained constant during the measurement periods. RESULTS: Ten ARDS patients were included. A significant PaCO(2) decrease was observed at each humidification system dead-space reduction, compared to baseline: PaCO(2 )=80.3+/-20 mmHg at DSh(120) compared to PaCO(2 )=63.6+/-13 mmHg at DSh(0) ( p<0.05). No changes were observed for hemodynamic and ventilatory parameters between the different humidification devices. CONCLUSION: Artificial airway dead-space reduction allows a significant PaCO(2) reduction. Independently of any respiratory mechanical changes, this very simple maneuver may be of importance when low tidal volume ventilation is used in ARDS patients, and when PaCO(2) lowering is warranted.
OBJECTIVE: To evaluate the effects of the humidification device on respiratory, hemodynamic and gas exchange parameters in acute respiratory distress syndrome (ARDS) patients. DESIGN: A prospective open study. SETTING: A medical intensive care unit of a university hospital. PATIENTS: Acute respiratory distress syndromepatients, with hypercapnia (PaCO(2)>60 mmHg). INTERVENTION: A progressive reduction of the humidification system dead space (DSh). The following five conditions were tested sequentially: (1). heat and moisture exchanger (internal volume=95 ml) with a tracheal closed-suction system (internal volume=25 ml; total DSh=120 ml), (2). heat and moisture exchanger (internal volume=45 ml) with the closed-suction system (DSh=70 ml), (3). heat and moisture exchanger (internal volume=25 ml) with the closed-suction system (DSh=50 ml), (4). heated humidifier with the closed-suction system (DSh=25 ml) and (5). heated humidifier alone (DSh=0 ml). Recordings were performed at baseline and every 30 min after each artificial dead-space reduction. All ventilatory settings remained constant during the measurement periods. RESULTS: Ten ARDSpatients were included. A significant PaCO(2) decrease was observed at each humidification system dead-space reduction, compared to baseline: PaCO(2 )=80.3+/-20 mmHg at DSh(120) compared to PaCO(2 )=63.6+/-13 mmHg at DSh(0) ( p<0.05). No changes were observed for hemodynamic and ventilatory parameters between the different humidification devices. CONCLUSION: Artificial airway dead-space reduction allows a significant PaCO(2) reduction. Independently of any respiratory mechanical changes, this very simple maneuver may be of importance when low tidal volume ventilation is used in ARDSpatients, and when PaCO(2) lowering is warranted.
Authors: Edward Abraham; Peter Andrews; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Geoffrey Dobb; Jean-Yves Fagon; Johan Groeneveld; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Michael Pinsky; Peter Radermacher; Marco Ranieri; Christian Richard; Robert Tasker; Benoît Vallet Journal: Intensive Care Med Date: 2004-05-15 Impact factor: 17.440
Authors: F Cerpa; D Cáceres; C Romero-Dapueto; C Giugliano-Jaramillo; R Pérez; H Budini; V Hidalgo; T Gutiérrez; J Molina; J Keymer Journal: Open Respir Med J Date: 2015-06-26