Users Online: 1389 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 


RSACP wishes to inform that it shall be discontinuing the dispatch of print copy of JOACP to it's Life members. The print copy of JOACP will be posted only to those life members who send us a written confirmation for continuation of print copy.
Kindly email your affirmation for print copies to dranjugrewal@gmail.com preferably by 30th June 2019.

 

 
Table of Contents
LETTER TO EDITOR
Year : 2013  |  Volume : 29  |  Issue : 2  |  Page : 285-286

Malfunction of heat and moisture exchanger filters: Causality or unresolved problem?


1 Department of Critical Care, Division of Anesthesiology and Critical Care, Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain
2 Department of Critical Care, M.D. Anderson Cancer Center, Houston, Texas, United States

Date of Web Publication13-May-2013

Correspondence Address:
Antonio M Esquinas
Intensive Care Unit, Hospital Morales Meseguer; Murcia, Avenida Marqués de Los Velez s/n Murcia. 30500
Spain
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.111748

Rights and Permissions

How to cite this article:
Esquinas AM, Pravinkumar S E. Malfunction of heat and moisture exchanger filters: Causality or unresolved problem?. J Anaesthesiol Clin Pharmacol 2013;29:285-6

How to cite this URL:
Esquinas AM, Pravinkumar S E. Malfunction of heat and moisture exchanger filters: Causality or unresolved problem?. J Anaesthesiol Clin Pharmacol [serial online] 2013 [cited 2019 Oct 21];29:285-6. Available from: http://www.joacp.org/text.asp?2013/29/2/285/111748

Dear Editor,

We read with great interest the case report by Bajwa, et al. [1] The authors highlight the seriousness of HMEF malfunction leading to airway obstruction that could result in catastrophic patient outcome, especially during anesthesia for operative procedures. It is also concerning that such device malfunctions may seldom trigger an alarm, which is intended to alert the anesthesiologist. Fortunately, the expertise and clinical acumen of the anesthesiologists caring for the patient had saved the day.

There are many causes which may determine a loss of HMEF efficiency such as described by the authors. [2] Several published articles describe the deleterious effects such as barotrauma and variable loss of humidification. [2],[3],[4]

We have carefully read this article on complications associated with HMEF malfunction. [1] If these malfunctions are considered to be rare and unusual, still are under-recognized and unnoticed, leading to serious harm to the patient. The use of HMEF and its associated malfunction is still a matter of debate among anesthesiologists. Currently there is not epidemiologic or clear information about this topic and clinical implications.

First, we agree with the authors that this paper highlights the lack of automatic detection systems for malfunctioning disposable devices that are added to the breathing circuit. [1] This raises the need for incorporating alternative detection alarms and even international policy. At present, only heated humidifiers have alarms for their malfunction and the detection alarms are still lacking for other MME devices. This is crucial point during prolonged mechanical ventilation [5] and monitoring ventilatory parameters. [6]

Second, there are not any available clinical protocols or training manuals to evaluate HMEF efficacy, or identify its potential manufacturing defects prior to clinical application. [2],[3],[4] Our recommendations to authors is that only a preventive strategy with meticulous attention to both disposable and non-disposable equipment used, could avoid a life threatening circumstance in the operating room, weaning [5] and prolonged mechanical ventilation. [7],[ 8] Third, our recommendations are that HME should incorporate a system of effective humidity, internal resistance and integrity along with a detection system when they fail.

Our key home messages in this study are a) this is an unresolved technical and clinical problem. b) Qualitative survey of practicing anesthesiologists would provide more insight in to the prevalence of what appears to be an 'unusual' occurrence of a very serious HMEF malfunction and c) upcoming trials should incorporate aspects of safety on humidification devices utilized.

 
  References Top

1.Bajwa SJ, Singh A. Failed ventilation due to heat and moisture exchanger filters malfunction. J Anaesthesiol Clin Pharmacol 2012;28:269-70.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Kapadia FN, Bajan KB, Singh S, Mathew B, Nath A, Wadkar S. Changing patterns of airway accidents in intubated ICU patients. Intensive Care Med 2001;27:296-300.  Back to cited text no. 2
    
3.Cohen IL, Weinberg PF, Fein IA, Rowinski GS. Endotracheal tube occlusion associated with the use of heat and moisture exchangers in the intensive care unit. Crit Care Med 1988;16:277-9.  Back to cited text no. 3
    
4.Mansor M, Chan L. Critical incident involving a heat and moisture exchanger with attached flexible connector. Anaesth Intensive Care 1999;27:114-5.  Back to cited text no. 4
    
5.Girault C, Breton L, Richard JC, Tamion F, Vandelet P, Aboab J, et al. Mechanical effects of airway humidification devices in difficult to wean patients. Crit Care Med 2003;31:1306-11.  Back to cited text no. 5
    
6.Fujita Y, Imanaka H, Fujino Y, Takeuchi M, Tomita T, Mashimo T, et al. Effect of humidifying devices on the measurement of tidal volume by mechanical ventilators. J Anesth 2006;20:166-72.  Back to cited text no. 6
    
7.Thomachot L, Vialet R, Viguier JM, Sidier B, Roulier P, Martin C. Efficacy of heat and moisture exchangers after changing every 48 hours rather than 24 hours. Crit Care Med 1998;26:477-81.  Back to cited text no. 7
    
8.Villafane MC, Cinnella G, Lofaso F, Isabey D, Harf A, Lemaire F. Gradual reduction of endotracheal tube diameter during mechanical ventilation via different humidification devices. Anesthesiology 1996;85:1341-9.  Back to cited text no. 8
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   References

 Article Access Statistics
    Viewed874    
    Printed33    
    Emailed1    
    PDF Downloaded193    
    Comments [Add]    

Recommend this journal