Anest. intenziv. Med. 2024;35(1):31-37 | DOI: 10.36290/aim.2024.001

Heat and moisture exchangers in intensive care: benefits and risks of their use in mechanically ventilated critically ill patientsReview Article

Línková Š., Rambousková K., Jiroutková K., Duška F.

Klinika anesteziologie a resuscitace 3. LF UK a FNKV Praha

The upper airway naturally warms and humidifies inspired air. For patients with artificial airways, this function is assumed by respiratory care devices, utilizing passive (HME, Heat and Moisture Exchangers) or active humidification. Despite no observed differences in clinical outcomes between these methods in randomised trials with critically ill patients, each has its particular benefits. HME, being technically simpler, is favoured in patients without respiratory pathologies, who are expected to be on only short-term mechanical ventilation (< 4 days). For other ventilated patients, active humidification might be more appropriate, especially when HME's efficacy is limited due to high inspiratory flow, patient hypothermia, contamination risk, or in patients sensitive to increased dead space, such as in ARDS. This paper explores the physiological principles, experimental findings, and clinical data regarding respiratory humidification in intensive care. It also highlights the disparity in recommendations on the frequency of filter changes. Manufacturers' guidelines often do not consider the risks associated with frequent circuit disconnection, and there is a noticeable absence of experimental data on this topic. This paper seeks to offer a holistic understanding of respiratory humidification in intensive care, coupled with actionable recommendations for clinical practice.

Keywords: heat and moisture exchangers, HME, respiratory care, critically ill, mechanical ventilation.

Received: August 28, 2023; Revised: November 21, 2023; Accepted: January 2, 2024; Prepublished online: February 7, 2024; Published: March 28, 2024  Show citation