Impact of leaks and ventilation parameters on the efficacy of humidifiers during home ventilation for tracheostomized patients: a bench study.

backgroundDuring invasive ventilation, the upper airway is bypassed and no longer participates in humidification of inspired gases, which is essential to avoid harmful consequences such as endotracheal tube occlusion. In the case of increased air flow, especially in the presence of leaks (intentional or unintentional), the humidification provided by humidifiers may become ineffective. The objective of this bench study was to evaluate the quality of humidification provided by heated humidifiers under various home ventilation conditions.

methodsFive heated humidifiers were tested in eight configurations combining circuit (expiratory valve or vented circuit), tidal volume (600 or 1000 mL) and presence of unintentional leak. Absolute humidity (AH) was measured at the upstream of the test lungs, which were placed in a 34 °C environmental chamber in order to simulate body temperature.

resultsThe AH measured in the valve circuit ranged between 30 mg/L and 40 mg/L and three out of the five humidifiers achieved an AH higher than the recommended level (33 mg/L). With the vented circuit without unintentional leak, when tidal volume was set at 600 mL, all humidifiers reached an AH higher than 33 mg/L except one device; when the tidal volume was set at 1000 mL and unintentional leak was present, four out of the five humidifiers provided an AH lower than 33 mg/L.

conclusionThis study shows that, except under certain home ventilation conditions, such as high tidal volumes with unintentional leak in vented circuit, most heated humidifiers ensure sufficient humidification to avoid the risk of side effect in patients.