Effects of a heat and moisture exchanger and a heated humidifier on respiratory mucus in patients undergoing mechanical ventilation

Effects of a heat and moisture exchanger and a heated humidifier on respiratory mucus in patients undergoing mechanical ventilation

Autor Nakagawa, N. K. Google Scholar
Macchione, M. Google Scholar
Petrolino, HMS Google Scholar
Guimaraes, E. T. Google Scholar
King, M. Google Scholar
Saldiva, PHN Google Scholar
Lorenzi, G. Google Scholar
Instituição Universidade de São Paulo (USP)
Hosp Sirio Libanes
Universidade Federal de São Paulo (UNIFESP)
Pulm Res Grp
Resumo Objective: To evaluate the effects of a heat and moisture exchanger and a heated humidifier on respiratory mucus and transportability by cilia and cough in patients undergoing invasive mechanical ventilation (up to 72 hrs).Design: Prospective, randomized, clinical study.Setting: General intensive care unit and university research laboratory.Patients: A total of 32 consecutive patients with acute respiratory failure, who were intubated and mechanically ventilated in the intensive care unit setting, were enrolled in the study.interventions: Patients were randomly assigned to receive as a humidifying system a heat and moisture exchanger (HME) or heated humidified water (HHW) at the onset of mechanical ventilation (time 0). Respiratory mucus samples were collected by suction using a sterile technique at time 0, 24, 48, and 72 hrs of mechanical ventilation.Measurements and Main Results: Eleven patients were excluded from this study because of either extubation or death before 72 hrs of mechanical ventilation, leaving 12 patients in the HME group and nine patients in the HHW group. Ventilatory variables including minute volume, mean airway pressure, positive end-expiratory pressure, Fio(2), as well as Pao(2)/Fio(2) ratio, fluid balance (last 6 hrs), furosemide, and inotrope administration (last 4 hrs) were recorded. in vitro mucus transportability by cilia was evaluated on the mucus-depleted frog palate model, and the results were expressed as the mucus transport rate. Cough clearance (an estimation of the interaction between the flow of air and the mucus lining the bronchial walls) was measured using a simulated cough machine, the results being expressed in millimeters. Mucus wettability was measured by the contact angle between a mucus sample drop and a flat glass surface. Mucus theologic properties (mechanical impedance [log G*] and the ratio between viscosity and elasticity [tan delta]) were measured using a magnetic microrheometer at 1 and 100 cGy/sec deformation frequency. the two humidification groups were comparable in terms of the Acute Physiology and Chronic Health Evaluation II score, age, gender, ventilatory variables, fluid balance, use of inotropes, and furosemide.Conclusion: Ours results indicate that air humidification with either HME or HHW at 32 degrees C (89.6 degrees F) has similar effects on mucus theologic properties, contact angle, and transportability by cilia in patients undergoing mechanical ventilation, except for transportability by cough, which diminished after 72 hrs of mechanical ventilation in the HME group (p = .0441).
Palavra-chave mechanical ventilation
humidification
heat and moisture exchanger
mucus
rheology
mucociliary clearance
cough
Idioma Inglês
Data de publicação 2000-02-01
Publicado em Critical Care Medicine. Philadelphia: Lippincott Williams & Wilkins, v. 28, n. 2, p. 312-317, 2000.
ISSN 0090-3493 (Sherpa/Romeo, fator de impacto)
Publicador Lippincott Williams & Wilkins
Extensão 312-317
Fonte http://dx.doi.org/10.1097/00003246-200002000-00004
Direito de acesso Acesso restrito
Tipo Artigo
Web of Science WOS:000085543300004
Endereço permanente http://repositorio.unifesp.br/handle/11600/26250

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