• Alexander Doyle, Maryanne Mariyaselvam, Gayathri Wijewardena, Natalie English, Emma Gent, and Peter Young.
• Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, UK, PE30 4ET; Specialty trainee, Barts and the London School of Anaesthesia, The Royal London Hospital, Whitechapel, London, UK, E1 1BB.
• J Crit Care. 2015 Aug 1;30(4):863.e1-3.

PurposeHeat and moisture exchangers (HMEs) and heated humidifiers (HHs) may be used together inadvertently. Such an incident occurred at our institution resulting in airway occlusion.Material And MethodsA bench-top study was conducted to compare the incidence of airway occlusion when using (1) no airway humidification, (2) HME alone, (3) HH alone, and (4) both HME and HH in combination as part of a standard breathing circuit.ResultsThe simultaneous use of a HME and a HH was associated with a reduction in tidal volume (no airway humidification, P ≤ .05; HME alone, P ≤ .01; and HH alone, P ≤ .01) and an increased incidence of airway occlusion (no airway humidification, 0/7; HME alone, 0/7; HH alone, 0/7; and HME and HH in combination, 7/7; P < .0001).ConclusionsThe use of a HME and a HH in combination is likely to result in airway occlusion. Precautions should be taken to ensure that both systems are not used together in clinical practice.Copyright © 2015 Elsevier Inc. All rights reserved.

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