The Science Journal of the American Association for Respiratory Care
INTRODUCTION: Heat Moisture Exchangers (HME's) have been proven to be effective in conditioning inspired gases in mechanically ventilated adult populations. The reported advantages of HME's include; cost reduction and decreased bacterial colonization. Few studies have been conducted in pediatric infants who require short-term (<96 hours) mechanical ventilation following cardiothoracic surgery. The purpose of this study is to evaluate the safety and efficacy of HME's in mechanically ventilated pediatric patients.
Methods: All mechanically ventilated pediatric patients, weighing greater than 10 kilograms, undergoing cardiothoracic surgery at the University of Michigan Medical Center were considered candidates for this study. Patients were excluded if any of the following conditions were encountered; extremely thick, tenacious secretions, >20% cuff leak, decreased ability to maintain body temperature or increased need for prolonged (>96 hrs) mechanical ventilation. Patients were sequentially enrolled, and a non-heated ventilator circuit with HME was employed during and following surgery. Each patient was monitored to document presence or absence of adverse events or complications potentially associated with the use of HME's and non-heated ventilator circuits.
Results: No adverse events or complications were observed in any of the 32 patients enrolled in this study. Two patients were changed from an HME to a heated wire circuit during the study. One patient required prolonged mechanical ventilation and 1 patient developed a significant (>20%) cuff leak. The average duration of mechanical ventilation in this study population was 13.05 hours. Our average cost savings associated with the use of non-heated ventilator circuits + HME was $20.54 per patient compared to heated ventilator circuits alone. Our department cost benefit analysis projects an annual saving of $6,162.00 associated with non-heated circuits + HME's in this population.
Conclusions: HME's are a safe and cost effective method to condition inspired gases in mechanically ventilated pediatric cardiothoracic patients. Further studies are warranted to evaluate the additional potential advantage of decreased bacterial colonization in this population.