• Samir Jaber, Gérald Chanques, Stefan Matecki, Michèle Ramonatxo, Bruno Souche, Pierre-François Perrigault, and Jean-Jacques Eledjam.
• Unité de Réanimation et de Transplantation-Département d'Anesthésie-Réanimation B, CHU de Montpellier Hôpital Saint Eloi, 80 avenue Augustin Fliche, 34295 Montpellier Cedex, France. jaber@creteil.inserm.fr
• Intensive Care Med. 2002 Nov 1;28(11):1590-4.

ObjectiveTo compare the short-term effects of a heat and moisture exchanger (HME) and a heated humidifier (HH) during non-invasive ventilation (NIV).DesignProspective, clinical investigation.SettingIntensive care unit of a university hospital.PatientsTwenty-four patients with acute respiratory failure (ARF).InterventionEach patient was studied with a HME and a HH in a random order during two consecutive 20min periods of NIV.Measurements And ResultsRespiratory rate (RR), expiratory tidal volume (VTe) and expiratory minute ventilation (VE) were measured during the last 5 min of each period and blood gases were measured. Mean pressure support and positive end-expiratory pressure levels were, respectively, 15+/-4 and 6+/-2 cmH(2)O. VE was significantly greater with HME than with HH (14.8+/-4.8 vs 13.2+/-4.3 l/min; p<0.001). This increase in VE was the result of a greater RR for HME than for HH (26.5+/-10.6 vs 24.1+/-9.8 breaths/min; p=0.002), whereas the VT for HME was similar to that for HH (674+/-156 vs 643+/-148 ml; p=0.09). Arterial partial pressure of carbon dioxide (PaCO(2)) was significantly higher with a HME than with a HH (43.4+/-8.9 vs 40.8+/-8.2 mmHg; p<0.005), without significantly changing oxygenation.ConclusionDuring NIV the increased dead space of a HME can negatively affect ventilatory function and gas exchange. The effect of HME dead space may decrease efficiency of NIV in patients with ARF.

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