Zusammenfassung
In einer prospektiven klinischen Studie an 49 intubierten und kontrolliert beatmeten Patienten wurde gezeigt, daß die inspiratorischen Befeuchtungsleistungen des HME DAR Hygrobac S und des aktiven Befeuchters Fisher & Paykel MR 630 B äquivalent sind (33,7± 1,85 vs. 34,1±2,62 mgH 2 O/l). Bei bestimmungsgemäßem Einsatz (tubusnahe Plazierung bzw. inspiratorische Atemgastemperatur von 34 °C) und Tidalvolumina zwischen 440 und 1190 ml (Mittel 658±148 ml) gewährleisteten beide Systeme eine physiologische Klimatisierung der Atemluft. Die geringgradige Erhöhung der inspiratorischen Resistance durch die HME (3,1±2,5 mbar/l/s) muß ggf. bei der schwierigen Respiratorentwöhnung mit berücksichtigt werden. Die Verwendung von HME ist erheblich kostengünstiger und weniger personalintensiv als der Einsatz von aktiven Befeuchtungssystemen. Leistungsstarke HME stellen damit eine gute Alternative zu aktiven Befeuchtungssystemen in der Intensivbeatmung dar.
Abstract
Heat and moisture exchangers (HME) are used as artificial noses for intubated patients to prevent damage resulting from dry and cold inspired gases. HME collect a large fraction of the heat and moisture of the expired air, adding them to the subsequent inspired breath. In a prospective clinical study the air-conditioning capacity of a heated humidifier was compared with a hygroscopic HME.
Methods. The water content of the ventilated air of 49 intensive care patients requiring artificial ventilation with tidal volumes between 440 and 1,190 ml (mean 658±148 ml) was examined. Each patient was ventilated in sequence with an HME (DAR Hygrobac S) and a heated humidifier (Fisher & Paykel MR 630 B). The temperature of the air in the inspiratory limb was maintained at 34 °C. The water content of the ventilated air was determined under steady-state conditions directly at the tracheal tube or between tracheal tube and HME using a new, high-resolution humidity meter. The results were compared with the absolute water loss of the exhaled air at the gas outlet of the ventilator as an expression of the water loss from the lower airways. Airway resistance was calculated by a standard formula. The daily running costs for both HME and heated humidifier were estimated.
Results and discussion. Moisture retention was equivalent in both the HME and the heated humidifier (33.7±1.85 bzw. 34.1±2.62 mgH2O/l). These data show that modern HMEs are able to maintain physiological air-conditioning even in long-term ventilated patients. The small increase in airway resistance associated with HMEs (3.1±2.5 mbar/l·s) has to be noted in difficult weaning procedures. Both labour and costs per day are significantly less with HMEs (8.60 vs. 21.70 DM).
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Eingegangen am 26. Mai 1995 Angenommen am 30. Dezember 1995
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Rathgeber, J., Henze, D. & Züchner, K. Atemgasklimatisierung mit leistungsfähigen HME (Heat and Moisture Exchanger) – eine effektive und kostengünstige Alternative zu aktiven Befeuchtern bei beatmeten Patienten . Anaesthesist 45, 518–525 (1996). https://doi.org/10.1007/s001010050285
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DOI: https://doi.org/10.1007/s001010050285