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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 |
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| Authors: | François Lellouche E L’Her F Abroug N Deye P O Rodriguez A Rabbat S Jaber M Fartoukh G Conti C Cracco J C Richard J D Ricard H Mal H Mentec F Loisel J C Lacherade S Taillé L Brochard |
| Institution: | 1. Service de Réanimation Médicale, H?pital Henri Mondor, Créteil, France 2. Service de Soins Intensifs, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec, G1V4G5, Canada 3. Service de Réanimation Médicale, H?pital de la Cavale Blanche, Brest, France 4. Service de Réanimation Médicale, H?pital Bourguiba, Monastir, Tunisia 5. Service de Réanimation Médicale, H?pital Européen Georges Pompidou, Paris, France 6. Servicio de Terapia Intensiva y Neumonología, CEMIC (Centro de Educación Médica e Investigaciones Clínicas), Buenos Aires, Argentina 7. Service de Réanimation Médicale, H?tel Dieu, Paris, France 8. Service de Réanimation Chirurgicale, H?pital Saint Eloi, Montpellier, France 9. Service de Réanimation Médicale, H?pital Tenon, Paris, France 10. Istituto di anestesiologia e Rianimazione, Università Cattolica Policlinico A. Gemelli, Rome, Italy 11. Service de Réanimation Médicale, H?pital de la Pitié Salpétrière, Paris, France 12. Service de Réanimation Médicale, CHU de Rouen, Rouen, France 13. Service de Réanimation Médicale, H?pital Louis Mourier, Colombes, France 14. Service de Réanimation Médicale, H?pital Beaujon, Clichy, France 15. Service de Réanimation Médicale, H?pital Victor Dupouy, Argenteuil, France 16. Service de Soins Intensifs, H?pital de l’Enfant Jésus, Québec, Canada 17. Service de Réanimation Médicale, Centre hospitalier intercommunal, Poissy, France |
| Abstract: | PurposeThe 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.MethodsWe 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.ResultsOf 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).ConclusionsIn 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. |
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