Effects of heat and moisture exchangers on minute ventilation, ventilatory drive, and work of breathing during pressure-support ventilation in acute respiratory failure
OBJECTIVE To evaluate the effect of two commonly used heat and moisture exchangers on respiratory function and gas exchange in patients with acute respiratory failure during pressure-support ventilation. DESIGN Prospective, randomized trial. SETTING Intensive care unit of a university hospital. PATI...
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| Veröffentlicht in: | Critical care medicine 1996-07, Vol.24 (7), p.1184-1188 |
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| creator | Pelosi, Paolo Solca, Maurizio Ravagnan, Irene Tubiolo, Daniela Ferrario, Lara Gattinoni, Luciano |
| description | OBJECTIVE To evaluate the effect of two commonly used heat and moisture exchangers on respiratory function and gas exchange in patients with acute respiratory failure during pressure-support ventilation.
DESIGN Prospective, randomized trial.
SETTING Intensive care unit of a university hospital.
PATIENTS Fourteen patients with moderate acute respiratory failure, receiving pressure-support ventilation.
INTERVENTIONS Patients were assigned randomly to two treatment groups, in which two different heat and moisture exchangers were usedHygroster Registered Trademark (DAR S.p.A., Mirandola, Italy) with higher deadspace and lower resistance (group 1, n equals 7), and Hygrobac-S Registered Trademark (DAR S.p.A.) with lower deadspace and higher resistance (group 2, n equals 7). Patients were assessed at three pressure-support levelsa) baseline (10.3 plus minus 2.4 cm H2 O for group 1, 9.3 plus minus 1.3 cm H2 O for group 2); b) 5 cm H2 O above baseline; and c) 5 cm H2 O below baseline. Measurements obtained with the heat and moisture exchangers were compared with those values obtained using the standard heated hot water humidifier.
MEASUREMENTS AND MAIN RESULTS At baseline pressure-support ventilation, the insertion of both heat and moisture exchangers induced in all patients a significant increase in the following parametersminute ventilation (12.4 plus minus 3.2 to 15.0 plus minus 2.6 L/min for group 1, and 11.8 plus minus 3.6 to 14.2 plus minus 3.5 L/min for group 2); static intrinsic positive end-expiratory pressure (2.9 plus minus 2.0 to 5.1 plus minus 3.2 cm H2 O for group 1, and 2.9 plus minus 1.7 to 5.5 plus minus 3.0 cm H2 O for group 2); ventilatory drive, expressed as P0.1 (2.7 plus minus 2.0 to 5.2 plus minus 4.0 cm H2 O for group 1, and 3.3 plus minus 2.0 to 5.3 plus minus 3.0 cm H2 O for group 2); and work of breathing, expressed as either power (8.8 plus minus 9.4 to 14.5 plus minus 10.3 joule/min for group 1, and 10.5 plus minus 7.4 to 16.8 plus minus 11.0 joule/min for group 2) or work per liter of ventilation (0.6 plus minus 0.6 to 1.0 plus minus 0.7 joule/L for group 1, and 0.8 plus minus 0.4 to 1.1 plus minus 0.5 joule/L for group 2). These increases also occurred when pressure-support ventilation was both above and below the baseline level, although at high pressure support the increase in work of breathing with heat and moisture exchangers was less evident. Gas exchange was unaffected by heat and moisture exchangers, as minute ventilation incre |
| doi_str_mv | 10.1097/00003246-199607000-00020 |
| format | Article |
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DESIGN Prospective, randomized trial.
SETTING Intensive care unit of a university hospital.
PATIENTS Fourteen patients with moderate acute respiratory failure, receiving pressure-support ventilation.
INTERVENTIONS Patients were assigned randomly to two treatment groups, in which two different heat and moisture exchangers were usedHygroster Registered Trademark (DAR S.p.A., Mirandola, Italy) with higher deadspace and lower resistance (group 1, n equals 7), and Hygrobac-S Registered Trademark (DAR S.p.A.) with lower deadspace and higher resistance (group 2, n equals 7). Patients were assessed at three pressure-support levelsa) baseline (10.3 plus minus 2.4 cm H2 O for group 1, 9.3 plus minus 1.3 cm H2 O for group 2); b) 5 cm H2 O above baseline; and c) 5 cm H2 O below baseline. Measurements obtained with the heat and moisture exchangers were compared with those values obtained using the standard heated hot water humidifier.
MEASUREMENTS AND MAIN RESULTS At baseline pressure-support ventilation, the insertion of both heat and moisture exchangers induced in all patients a significant increase in the following parametersminute ventilation (12.4 plus minus 3.2 to 15.0 plus minus 2.6 L/min for group 1, and 11.8 plus minus 3.6 to 14.2 plus minus 3.5 L/min for group 2); static intrinsic positive end-expiratory pressure (2.9 plus minus 2.0 to 5.1 plus minus 3.2 cm H2 O for group 1, and 2.9 plus minus 1.7 to 5.5 plus minus 3.0 cm H2 O for group 2); ventilatory drive, expressed as P0.1 (2.7 plus minus 2.0 to 5.2 plus minus 4.0 cm H2 O for group 1, and 3.3 plus minus 2.0 to 5.3 plus minus 3.0 cm H2 O for group 2); and work of breathing, expressed as either power (8.8 plus minus 9.4 to 14.5 plus minus 10.3 joule/min for group 1, and 10.5 plus minus 7.4 to 16.8 plus minus 11.0 joule/min for group 2) or work per liter of ventilation (0.6 plus minus 0.6 to 1.0 plus minus 0.7 joule/L for group 1, and 0.8 plus minus 0.4 to 1.1 plus minus 0.5 joule/L for group 2). These increases also occurred when pressure-support ventilation was both above and below the baseline level, although at high pressure support the increase in work of breathing with heat and moisture exchangers was less evident. Gas exchange was unaffected by heat and moisture exchangers, as minute ventilation increased to compensate for the higher deadspace produced in the circuit by the insertion of heat and moisture exchangers.
CONCLUSIONS The tested heat and moisture exchangers should be used carefully in patients with acute respiratory failure during pressure-support ventilation, since these devices substantially increase minute ventilation, ventilatory drive, and work of breathing. However, an increase in pressure-support ventilation (5 to 10 cm H sub 2 O) may compensate for the increased work of breathing.(Crit Care Med 1996; 24:1184-1188)</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/00003246-199607000-00020</identifier><identifier>PMID: 8674333</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: Williams & Wilkins</publisher><subject>Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Emergency and intensive respiratory care ; Female ; Hot Temperature ; Humans ; Humidity ; Intensive care medicine ; Intensive Care Units ; Male ; Medical sciences ; Middle Aged ; Positive-Pressure Respiration ; Prospective Studies ; Respiration - physiology ; Respiration, Artificial - methods ; Respiratory Dead Space ; Respiratory Distress Syndrome, Adult - physiopathology ; Respiratory Insufficiency - physiopathology ; Respiratory Insufficiency - therapy ; Work of Breathing - physiology</subject><ispartof>Critical care medicine, 1996-07, Vol.24 (7), p.1184-1188</ispartof><rights>Williams & Wilkins 1996. All Rights Reserved.</rights><rights>1996 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4790-dde547706f6772d2b9c057cec9adc781d7e20ef8c00edf7e19b79f7e2af358833</citedby><cites>FETCH-LOGICAL-c4790-dde547706f6772d2b9c057cec9adc781d7e20ef8c00edf7e19b79f7e2af358833</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27907,27908</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3157871$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8674333$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pelosi, Paolo</creatorcontrib><creatorcontrib>Solca, Maurizio</creatorcontrib><creatorcontrib>Ravagnan, Irene</creatorcontrib><creatorcontrib>Tubiolo, Daniela</creatorcontrib><creatorcontrib>Ferrario, Lara</creatorcontrib><creatorcontrib>Gattinoni, Luciano</creatorcontrib><title>Effects of heat and moisture exchangers on minute ventilation, ventilatory drive, and work of breathing during pressure-support ventilation in acute respiratory failure</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE To evaluate the effect of two commonly used heat and moisture exchangers on respiratory function and gas exchange in patients with acute respiratory failure during pressure-support ventilation.
DESIGN Prospective, randomized trial.
SETTING Intensive care unit of a university hospital.
PATIENTS Fourteen patients with moderate acute respiratory failure, receiving pressure-support ventilation.
INTERVENTIONS Patients were assigned randomly to two treatment groups, in which two different heat and moisture exchangers were usedHygroster Registered Trademark (DAR S.p.A., Mirandola, Italy) with higher deadspace and lower resistance (group 1, n equals 7), and Hygrobac-S Registered Trademark (DAR S.p.A.) with lower deadspace and higher resistance (group 2, n equals 7). Patients were assessed at three pressure-support levelsa) baseline (10.3 plus minus 2.4 cm H2 O for group 1, 9.3 plus minus 1.3 cm H2 O for group 2); b) 5 cm H2 O above baseline; and c) 5 cm H2 O below baseline. Measurements obtained with the heat and moisture exchangers were compared with those values obtained using the standard heated hot water humidifier.
MEASUREMENTS AND MAIN RESULTS At baseline pressure-support ventilation, the insertion of both heat and moisture exchangers induced in all patients a significant increase in the following parametersminute ventilation (12.4 plus minus 3.2 to 15.0 plus minus 2.6 L/min for group 1, and 11.8 plus minus 3.6 to 14.2 plus minus 3.5 L/min for group 2); static intrinsic positive end-expiratory pressure (2.9 plus minus 2.0 to 5.1 plus minus 3.2 cm H2 O for group 1, and 2.9 plus minus 1.7 to 5.5 plus minus 3.0 cm H2 O for group 2); ventilatory drive, expressed as P0.1 (2.7 plus minus 2.0 to 5.2 plus minus 4.0 cm H2 O for group 1, and 3.3 plus minus 2.0 to 5.3 plus minus 3.0 cm H2 O for group 2); and work of breathing, expressed as either power (8.8 plus minus 9.4 to 14.5 plus minus 10.3 joule/min for group 1, and 10.5 plus minus 7.4 to 16.8 plus minus 11.0 joule/min for group 2) or work per liter of ventilation (0.6 plus minus 0.6 to 1.0 plus minus 0.7 joule/L for group 1, and 0.8 plus minus 0.4 to 1.1 plus minus 0.5 joule/L for group 2). These increases also occurred when pressure-support ventilation was both above and below the baseline level, although at high pressure support the increase in work of breathing with heat and moisture exchangers was less evident. Gas exchange was unaffected by heat and moisture exchangers, as minute ventilation increased to compensate for the higher deadspace produced in the circuit by the insertion of heat and moisture exchangers.
CONCLUSIONS The tested heat and moisture exchangers should be used carefully in patients with acute respiratory failure during pressure-support ventilation, since these devices substantially increase minute ventilation, ventilatory drive, and work of breathing. However, an increase in pressure-support ventilation (5 to 10 cm H sub 2 O) may compensate for the increased work of breathing.(Crit Care Med 1996; 24:1184-1188)</description><subject>Acute Disease</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Emergency and intensive respiratory care</subject><subject>Female</subject><subject>Hot Temperature</subject><subject>Humans</subject><subject>Humidity</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Positive-Pressure Respiration</subject><subject>Prospective Studies</subject><subject>Respiration - physiology</subject><subject>Respiration, Artificial - methods</subject><subject>Respiratory Dead Space</subject><subject>Respiratory Distress Syndrome, Adult - physiopathology</subject><subject>Respiratory Insufficiency - physiopathology</subject><subject>Respiratory Insufficiency - therapy</subject><subject>Work of Breathing - physiology</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kt9uFCEUxonR1G31EUy4MF51FIaZYbg0Tf-YNOlNvSYsHLpYBkZguvaNfEzZ7rrxRhJy8uV853dCPhDClHymRPAvpB7WdkNDhRgIr6qptyWv0Ir2rIpWsNdoRYggDesEe4tOc_5BCO16zk7QyTjwjjG2Qr8vrQVdMo4Wb0AVrILBU3S5LAkw_NIbFR4g1X7AkwtLAfwEoTiviovh_ChiesYmuSc4fyFsY3rcIdepMjcuPGCzpF2ZE-Rc0U1e5jmm8i8Nu4CV3q2optmlPdUq5-vAO_TGKp_h_aGeoe9Xl_cXN83t3fW3i6-3je54fawx0Heck8EOnLemXQtNeq5BC2U0H6nh0BKwoyYEjOVAxZqLWltlWT-OjJ2hT3vunOLPBXKRk8savFcB4pJlZXS8E7wax71Rp5hzAivn5CaVniUlcheS_BuSPIYkX0Kqox8OO5b1BOY4eEil9j8e-ipr5W1SQbt8tDHa85HTauv2tm30pWb06JctJFlj9GUj__dF2B_jga5x</recordid><startdate>199607</startdate><enddate>199607</enddate><creator>Pelosi, Paolo</creator><creator>Solca, Maurizio</creator><creator>Ravagnan, Irene</creator><creator>Tubiolo, Daniela</creator><creator>Ferrario, Lara</creator><creator>Gattinoni, Luciano</creator><general>Williams & Wilkins</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199607</creationdate><title>Effects of heat and moisture exchangers on minute ventilation, ventilatory drive, and work of breathing during pressure-support ventilation in acute respiratory failure</title><author>Pelosi, Paolo ; Solca, Maurizio ; Ravagnan, Irene ; Tubiolo, Daniela ; Ferrario, Lara ; Gattinoni, Luciano</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4790-dde547706f6772d2b9c057cec9adc781d7e20ef8c00edf7e19b79f7e2af358833</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Acute Disease</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Emergency and intensive respiratory care</topic><topic>Female</topic><topic>Hot Temperature</topic><topic>Humans</topic><topic>Humidity</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Positive-Pressure Respiration</topic><topic>Prospective Studies</topic><topic>Respiration - physiology</topic><topic>Respiration, Artificial - methods</topic><topic>Respiratory Dead Space</topic><topic>Respiratory Distress Syndrome, Adult - physiopathology</topic><topic>Respiratory Insufficiency - physiopathology</topic><topic>Respiratory Insufficiency - therapy</topic><topic>Work of Breathing - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pelosi, Paolo</creatorcontrib><creatorcontrib>Solca, Maurizio</creatorcontrib><creatorcontrib>Ravagnan, Irene</creatorcontrib><creatorcontrib>Tubiolo, Daniela</creatorcontrib><creatorcontrib>Ferrario, Lara</creatorcontrib><creatorcontrib>Gattinoni, Luciano</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pelosi, Paolo</au><au>Solca, Maurizio</au><au>Ravagnan, Irene</au><au>Tubiolo, Daniela</au><au>Ferrario, Lara</au><au>Gattinoni, Luciano</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of heat and moisture exchangers on minute ventilation, ventilatory drive, and work of breathing during pressure-support ventilation in acute respiratory failure</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>1996-07</date><risdate>1996</risdate><volume>24</volume><issue>7</issue><spage>1184</spage><epage>1188</epage><pages>1184-1188</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE To evaluate the effect of two commonly used heat and moisture exchangers on respiratory function and gas exchange in patients with acute respiratory failure during pressure-support ventilation.
DESIGN Prospective, randomized trial.
SETTING Intensive care unit of a university hospital.
PATIENTS Fourteen patients with moderate acute respiratory failure, receiving pressure-support ventilation.
INTERVENTIONS Patients were assigned randomly to two treatment groups, in which two different heat and moisture exchangers were usedHygroster Registered Trademark (DAR S.p.A., Mirandola, Italy) with higher deadspace and lower resistance (group 1, n equals 7), and Hygrobac-S Registered Trademark (DAR S.p.A.) with lower deadspace and higher resistance (group 2, n equals 7). Patients were assessed at three pressure-support levelsa) baseline (10.3 plus minus 2.4 cm H2 O for group 1, 9.3 plus minus 1.3 cm H2 O for group 2); b) 5 cm H2 O above baseline; and c) 5 cm H2 O below baseline. Measurements obtained with the heat and moisture exchangers were compared with those values obtained using the standard heated hot water humidifier.
MEASUREMENTS AND MAIN RESULTS At baseline pressure-support ventilation, the insertion of both heat and moisture exchangers induced in all patients a significant increase in the following parametersminute ventilation (12.4 plus minus 3.2 to 15.0 plus minus 2.6 L/min for group 1, and 11.8 plus minus 3.6 to 14.2 plus minus 3.5 L/min for group 2); static intrinsic positive end-expiratory pressure (2.9 plus minus 2.0 to 5.1 plus minus 3.2 cm H2 O for group 1, and 2.9 plus minus 1.7 to 5.5 plus minus 3.0 cm H2 O for group 2); ventilatory drive, expressed as P0.1 (2.7 plus minus 2.0 to 5.2 plus minus 4.0 cm H2 O for group 1, and 3.3 plus minus 2.0 to 5.3 plus minus 3.0 cm H2 O for group 2); and work of breathing, expressed as either power (8.8 plus minus 9.4 to 14.5 plus minus 10.3 joule/min for group 1, and 10.5 plus minus 7.4 to 16.8 plus minus 11.0 joule/min for group 2) or work per liter of ventilation (0.6 plus minus 0.6 to 1.0 plus minus 0.7 joule/L for group 1, and 0.8 plus minus 0.4 to 1.1 plus minus 0.5 joule/L for group 2). These increases also occurred when pressure-support ventilation was both above and below the baseline level, although at high pressure support the increase in work of breathing with heat and moisture exchangers was less evident. Gas exchange was unaffected by heat and moisture exchangers, as minute ventilation increased to compensate for the higher deadspace produced in the circuit by the insertion of heat and moisture exchangers.
CONCLUSIONS The tested heat and moisture exchangers should be used carefully in patients with acute respiratory failure during pressure-support ventilation, since these devices substantially increase minute ventilation, ventilatory drive, and work of breathing. However, an increase in pressure-support ventilation (5 to 10 cm H sub 2 O) may compensate for the increased work of breathing.(Crit Care Med 1996; 24:1184-1188)</abstract><cop>Hagerstown, MD</cop><pub>Williams & Wilkins</pub><pmid>8674333</pmid><doi>10.1097/00003246-199607000-00020</doi><tpages>5</tpages></addata></record> |
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| identifier | ISSN: 0090-3493 |
| ispartof | Critical care medicine, 1996-07, Vol.24 (7), p.1184-1188 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Acute Disease Adolescent Adult Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Emergency and intensive respiratory care Female Hot Temperature Humans Humidity Intensive care medicine Intensive Care Units Male Medical sciences Middle Aged Positive-Pressure Respiration Prospective Studies Respiration - physiology Respiration, Artificial - methods Respiratory Dead Space Respiratory Distress Syndrome, Adult - physiopathology Respiratory Insufficiency - physiopathology Respiratory Insufficiency - therapy Work of Breathing - physiology |
| title | Effects of heat and moisture exchangers on minute ventilation, ventilatory drive, and work of breathing during pressure-support ventilation in acute respiratory failure |
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