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  • Title: Changing heat and moisture exchangers every 48 hours rather than 24 hours does not affect their efficacy and the incidence of nosocomial pneumonia.
    Author: Djedaini K, Billiard M, Mier L, Le Bourdelles G, Brun P, Markowicz P, Estagnasie P, Coste F, Boussougant Y, Dreyfuss D.
    Journal: Am J Respir Crit Care Med; 1995 Nov; 152(5 Pt 1):1562-9. PubMed ID: 7582295.
    Abstract:
    Heat and moisture exchangers (HME) (Dar-Hygrobac II, Peters) can safely be used every 24 h for long-term mechanical ventilation and provide a cost-saving alternative to heated humidifiers. We have prospectively determined whether changing HMEs every 48 h only affects their clinical and bacteriological efficiency in a series of consecutive nonselected ICU patients requiring long-term mechanical ventilation. Two consecutive periods were compared. During period 1, HMEs were replaced every day; during period 2, they were changed every 48 h. Patients from the two periods were similar in terms of age and indication for and overall duration of MV (10 +/- 8.6 versus 10 +/- 9 d, p = 0.9). Minute ventilation and maximum values for peak airway pressure were identical during the two periods. These values were also identical after 1 and 2 d of HME use during period 2, indicating that HME resistance was not increased by prolonged use. Obstruction of the tracheal tube occurred only once in a period 1 patient. The results of quantitative cultures indicate that the maximum and mean levels of bacterial colonization during the two periods were similar for the pharynx, trachea, Y-connector, patient, and ventilator side of the HME. More importantly, the incidence of nosocomial pneumonia was similar during the two periods (6/61 versus 8/68, p = 0.7). Thus, prolonged HME use is safe and provides a substantial reduction in the cost of mechanical ventilation.
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