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This may be useful when selecting and comparing different devices. Although ranges as wide as 25–35 mgH2O have been suggested in the past, the figure of 30 mgH2O/l is recommended [7]. That is, a clinician wishing to select an appropriate humidifying device should make sure that this device delivers at least 30 mgH2O/l absolute humidity. Another definition of adequate humidification includes avoiding endotracheal tube occlusion. Some may argue that restricting adequate humidification to the risk of endotracheal occlusion is overly simplistic.

An algorithm for the selection of humidification devices for an adult intensive care unit (ICU) is provided in Fig. 4. 1 Acute Respiratory Distress Syndrome (ARDS) A significant improvement in PaCO2 is associated with the switch to an HH from an HME in patients who have ARDS [3]. Compensation for HME dead space is possible by increasing the set tidal volume. This compensation, however, increases peak airway pressure and mean airway pressure, which may not be acceptable in ARDS patients [1]. Therefore, if low-tidal-volume ventilation is used, such as in the case of ARDS and hypercapnia, an HH is the humidification system of choice.

26 mgH2O/l to reach the physiological values of alveolar gas: 44 mgH2O/l and a temperature of 37°C. 2 Hygroscopic HMEs To the simple physical process of the hydrophobic HME is added a chemical trapping of water in the hygroscopic compartment (Fig. 3). The hygroscopic layer is made of wool or plastic foam impregnated with a hygroscopic substance as the active element: calcium or lithium. Hygroscopic HMEs preserve patients’ heat and water better, and globally they recover 70% of expired heat and humidity (Fig.

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