SynthesisCritical care (London, England)2017
Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) in adult critically ill patients: a systematic review, meta-analysis and meta-regression of randomized controlled trials.
Synthesis in Critical care (London, England), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- Heat and moisture exchangers versus heated humidifiers for mechanically ventilated adults and children.The Cochrane database of systematic reviews · 2017Pooled it
- How can the collaboration between manufacturers of medical devices and bedside clinicians lead to improved applications of the devices?Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2026Article
- Invasive ventilator exhaust in critical care: aerosol transmission risks and management strategies-a narrative review.Critical care (London, England) · 2025Review
- Humidification in the Pediatric Intensive Care Unit: What We Know, What We Need.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- Effect of Heat and Moisture Exchanger vs Heated Humidifier on Ventilator-related Adverse Events in Children: A Pilot Randomized Controlled Trial.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025Article
- Consensus Statements on Airway Clearance Interventions in Intubated Critically Ill Patients-Protocol for a Delphi Study.Life (Basel, Switzerland) · 2025Article
- Tracheostomy Practice in the Italian Intensive Care Units: A Point-Prevalence Survey.Medicina (Kaunas, Lithuania) · 2025Observational
- Effect of humidification intervention combined with cluster nursing on ventilator-associated pneumonia in ICU patients.Frontiers in public health · 2025Observational
- Development of a New Method for Evaluating Heat and Moisture Exchanger Performance.Respiratory care · 2024Article
- Humidification during Invasive and Non-Invasive Ventilation: A Starting Tool Kit for Correct Setting.Medical sciences (Basel, Switzerland) · 2024Review
- Nursing Practice of Airway Care Interventions and Prone Positioning in ICU Patients with COVID-19-A Dutch National Survey.Journal of clinical medicine · 2024Article
- Establishment of evidence-based nursing review indicators for airway management of adult critical patients and analysis of obstacle factors.Nursing open · 2021Article
- Observational
- Airway Care Interventions for Invasively Ventilated Critically Ill Adults-A Dutch National Survey.Journal of clinical medicine · 2021Article
- Tidal Volume Lowering by Instrumental Dead Space Reduction in Brain-Injured ARDS Patients: Effects on Respiratory Mechanics, Gas Exchange, and Cerebral Hemodynamics.Neurocritical care · 2021Article
- Tracheostomy care and decannulation during the COVID-19 pandemic. A multidisciplinary clinical practice guideline.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2021Review
- Humidification during mechanical ventilation to prevent endotracheal tube occlusion in critically ill patients: A case control study.Annals of thoracic medicineArticle
Corrections and comments
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Authors and funding
7 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe aims of this systematic review and meta-analysis of randomized controlled trials are to evaluate the effects of active heated humidifiers (HHs) and moisture exchangers (HMEs) in preventing artificial airway occlusion and pneumonia, and on mortality in adult critically ill patients. In addition, we planned to perform a meta-regression analysis to evaluate the relationship between the incidence of artificial airway occlusion, pneumonia and mortality and clinical features of adult critically ill patients.
methodsComputerized databases were searched for randomized controlled trials (RCTs) comparing HHs and HMEs and reporting artificial airway occlusion, pneumonia and mortality as predefined outcomes. Relative risk (RR), 95% confidence interval for each outcome and I
resultsEighteen RCTs and 2442 adult critically ill patients were included in the analysis. The incidence of artificial airway occlusion (RR = 1.853; 95% CI 0.792-4.338), pneumonia (RR = 932; 95% CI 0.730-1.190) and mortality (RR = 1.023; 95% CI 0.878-1.192) were not different in patients treated with HMEs and HHs. However, in the subgroup analyses the incidence of airway occlusion was higher in HMEs compared with HHs with non-heated wire (RR = 3.776; 95% CI 1.560-9.143). According to the meta-regression, the effect size in the treatment group on artificial airway occlusion was influenced by the percentage of patients with pneumonia (β = -0.058; p = 0.027; favors HMEs in studies with high prevalence of pneumonia), and a trend was observed for an effect of the duration of mechanical ventilation (MV) (β = -0.108; p = 0.054; favors HMEs in studies with longer MV time).
conclusionsIn this meta-analysis we found no superiority of HMEs and HHs, in terms of artificial airway occlusion, pneumonia and mortality. A trend favoring HMEs was observed in studies including a high percentage of patients with pneumonia diagnosis at admission and those with prolonged MV. However, the choice of humidifiers should be made according to the clinical context, trying to avoid possible complications and reaching the appropriate performance at lower costs.
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