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

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.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Lellouche F,L'Her E,Abroug F,Deye N,Rodriguez PO,Rabbat A,Jaber S,Fartoukh M,Conti G,Cracco C,Richard JC,Ricard JD,Mal H,Mentec H,Loisel F,Lacherade JC,Taillé S,Brochard L

doi

10.1007/s00134-013-3145-z

subject

Has Abstract

pub_date

2014-02-01 00:00:00

pages

211-9

issue

eissn

0342-4642

issn

1432-1238

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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