HUMIDIFICATION IN THE INTENSIVE-CARE UNIT - PROSPECTIVE-STUDY OF A NEW PROTOCOL UTILIZING HEATED HUMIDIFICATION AND A HYGROSCOPIC CONDENSERHUMIDIFIER

Study objective: Determine the utility of a proposed algorithm in allo wing safe, efficient humidification in mechanically ventilated patient s using both a hygroscopic condenser humidifier (HCH) and heated humid ifier (HH). Design. A prospective study using an algorithm to chose hu midification devices based on physical examination and sputum characte ristics. Setting: All patients admitted to the surgical ICU. Patients: One hundred twenty consecutive patients requiring mechanical ventilat ion (MV) were studied. Interventions: Patients were examined by the at tending respiratory care practitioner and given either an HCH or HH. I f patients demonstrated any of the following-thick or tenacious secret ions, core temperature < 32-degrees-C, or bloody secretions-they were given an HH. All others used an HCH. if any of the above conditions oc curred during HCH use, the patient was given an HH. Measurements and r esults: Duration of ventilation, incidence of nosocomial pneumonia, ve ntilator circuit colonization, and mortality were determined for patie nts in each group. Cost of humidification devices, number of suctionin g procedures per day, and volume of saline solution instilled were als o recorded. Initially, 27 percent (32/120) of patients used an HH and 73 percent (88/120) used an HCH. During the study, ten patients requir ed changing to an HH during HCH use. Patients in the HH group were mor e likely to have preexisting lung disease and had a longer duration of ventilation (83 +/- 21 h) and higher mortality (21 percent). Patients in the HCH group were more likely to be postoperative, had shorter du rations of ventilation (38 +/- 14 h), and lower mortality (9 percent). There was no difference in the incidence of nosocomial pneumonia betw een the two groups (9 percent vs 6 percent) and endotracheal tube occl usion did not occur in either group. Circuit colonization was common i n the HH group (64 percent) but rare in the HCH group (5 percent). Cos t per day was significantly less for the HCH group ($4 vs $19.80). Pat ients who required a change from HCH to HH did so at a mean of 5 days. Conclusion: The proposed algorithm resulted in cost-efficient and saf e application of humidification devices in patients in the surgical IC U.