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Humidification in the intensive care unit. Prospective study of a new protocol utilizing heated humidification and a
R D Branson1, K Davis, R S Campbell
1Department of Surgery, University of Cincinnati Hospital.
Study Objective:
Determine the utility of a proposed algorithm in allowing safe, efficient humidification in mechanically ventilated patients using both a hygroscopic condenser humidifier (HCH) and heated humidifier (HH).
Design:
A prospective study using an algorithm to chose humidification devices based on physical examination and sputum characteristics.
Setting:
All patients admitted to the surgical ICU.
Patients:
One hundred twenty consecutive patients requiring mechanical ventilation (MV) were studied.
Interventions:
Patients were examined by the attending respiratory care practitioner and given either an HCH or HH. If patients demonstrated any of the following--thick or tenacious secretions, core temperature < 32 degrees C, or bloody secretions--they were given an HH. All others used an HCH. If any of the above conditions occurred during HCH use, the patient was given an HH.
Measurements And Results:
Duration of ventilation, incidence of nosocomial pneumonia, ventilator circuit colonization, and mortality were determined for patients in each group. Cost of humidification devices, number of suctioning procedures per day, and volume of saline solution instilled were also recorded. Initially, 27 percent (32/120) of patients used an HH and 73 percent (88/120) used an HCH. During the study, ten patients required changing to an HH during HCH use. Patients in the HH group were more 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 durations of ventilation (38 +/- 14 h), and lower mortality (9 percent). There was no difference in the incidence of nosocomial pneumonia between the two groups (9 percent vs 6 percent) and endotracheal tube occlusion did not occur in either group. Circuit colonization was common in the HH group (64 percent) but rate in the HCH group (5 percent). Cost per day was significantly less for the HCH group ($4 vs $19.80). Patients 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 safe application of humidification devices in patients in the surgical ICU.