Table 3.
Humidification systems: clinical considerations
| VAP | It is recommended not to select a humidification device based on its relationship with infection control |
| ARDS | The use of an active humidifier is suggested since it maintains its performance despite the ventilatory strategy used. It allows the optimization of the effective alveolar ventilation and decreases the VT and the instrumental dead space. |
| COPD | The use of an active humidifier is suggested since it does not increase the instrumental dead space or the ventilatory demand, without the risk of generating auto-PEEP. If using HME, change every 48 hours |
| Burned | The use of an active humidifier is suggested in patients with large body surfaces affected and inhalatory lesions due to its stable performance |
| Hypothermia | The use of an active humidifier is suggested in patients under a hypothermia strategy since they have demonstrated a better performance than HMEs and active HMEs |
| BPF | The use of an active humidifier is suggested in cases with an exhaled volume below 70% of the inhaled volume |
| NIV | Patients requiring ventilatory support for more than 1 hour are candidates for the use of a humidification device. The recommended device is an active humidifier with continuous flow ventilators with a one-branch circuit. In microprocessed ventilators with two-branch circuits, this recommendation is questionable. |
| Disconnection from MV | In patients with a problem in PaCO2 due their pathology or who present significant muscle weakness, the use of an active humidifier is recommended |
| Spontaneous ventilation | The use of a humidifier bottles as a conditioning system for the inhaled gases of a patient with artificial airways is discouraged |
VAP - ventilator-associated pneumonia; ARDS - acute respiratory distress syndrome; VT - tidal volume; COPD - chronic obstructive pulmonary disease; PEEP - positive end expiratory pressure; HME - heat and moisture exchanger; BPF - bronchopleural fistula; NIV - non-invasive mechanical ventilation; MV - mechanical ventilation; PaCO2 - carbon dioxide partial pressure.