Keywords :
Active humidification, Passive humidification, Ventilator-associated pneumonia
Citation Information :
Mahale N, Godavarthy P, Bahikar P, Jagadale M, Choudhary D. Prospective Analysis of Incidence of Ventilator-associated Pneumonia Associated with Active and Passive Humidification in SARS-CoV-2 Patients. Indian J Respir Care 2023; 12 (2):201-205.
Aim: Comparison of the incidence of ventilator-associated pneumonia (VAP) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients requiring mechanical ventilation using active and passive humidification. Materials and methods: The prospective study was carried out by the Department of Critical Care Medicine in a tertiary care hospital. Subjects were divided into two groups. Baseline demographic data was collected for both groups. In both the groups, the clinical pulmonary infection score (CPIS), which included—temperature, white blood cell (WBC) count, tracheal aspirate quantity, alveolar oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio, chest ray, and any pathogenic bacterial growth from tracheal aspirate, was documented, and the final score was analyzed, which predicted the incidence of VAP. The secondary outcomes studied were the independent variables, such as duration of ventilator support, mortality rate, and endotracheal tube (ETT) patency in both groups. Results: The intergroup distribution of primary outcome, including the distribution of CPIS parameters, did not differ significantly in both groups; that is, the VAP rate remained the same in both groups. Secondary outcomes, including duration of ventilator support and mortality rate, remained the same, whereas airway occlusion and peak pressure were higher in the patients receiving passive humidification. Conclusion: The incidence of VAP remained the same in both groups with the use of either active or passive humidification systems. Extended use of both systems resulted in the curtailment of ETT patency, whereas the use of a heated humidifier (HH) lowered the risk for artificial airway occlusion.
Pugin J, Auckenthaler R, Mili N, et al. Diagnosis of ventilator-associated pneumonia by bacteriologic analysis of bronchoscopic and nonbronchoscopic “blind” bronchoalveolar lavage fluid. Am Rev Respir Dis 1991;143(5 Pt 1):1121–1129. DOI: 10.1164/ajrccm/143.5_Pt_1
Villafane MC, Cinnella G, Lofaso F, et al. Gradual reduction of endotracheal tube diameter during mechanical ventilation via different humidification devices. Anesthesiology 1996;85(6):1341–1349. DOI: 10.1097/00000542-199612000-00015
Fartoukh M, Maitre B, Honoré S, et al. Diagnosing pneumonia during mechanical ventilation: the clinical pulmonary infection score revisited. Am J Respir Crit Care Med 2003;168(2):173–179. DOI: 10.1164/rccm.200212-1449OC
Hess DR, Kallstrom TJ, Mottram CD, et al. American Association for Respiratory Care are of the ventilator circuit and its relation to ventilator associated pneumonia. Respir Care 2003;48(9):869–879.
American Thoracic SocietyInfectious Diseases Society of America, Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171(4):388–416. DOI: 10.1164/rccm.200405-644ST
Kola A, Eckmanns T, Gaistmeier P. Efficacy of heat and moisturing exchangers in preventing ventilator-associated pneumonia: meta-analysis of randomized controlled trials. Intensive Care Med 2005;31(1):5–11. DOI: 10.1007/s00134-004-2431-1
Morán I, Bellapart J, Vari A, et al. Heat and moisture exchangers and heated humidifiers in acute lung injury/acute respiratory distress syndrome patients. Effects on respiratory mechanics and gas exchange. Intensive Care Med 2006;32(4):524–531. DOI: 10.1007/s00134-006-0073-1
Siempos II, Vardakas KZ, Kopterides P, et al. Impact of passive humidification on clinical outcomes of mechanically ventilated patients: a meta-analysis of randomized controlled trials. Crit Care Med 2007;35(12):2843–2851. DOI: 10.1097/01.ccm.0000295302.67973.9a
Zilberberg MD, Shorr AF. Ventilator-associated pneumonia: the clinical pulmonary infection score as a surrogate for diagnostics and outcome. Clin Infect Dis 2010;51 (Suppl 1):S131–S135. DOI: 10.1086/653062
Mo M, Liu SQ, Yang Y. [Efficacy of heat and moisture exchangers and heated humidifiers in preventing ventilator-associated pneumonia: a meta-analysis]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2011;23(9):513–517.
Gillies D, Todd DA, Foster JP, et al. Heat and moisture exchangers versus heated humidifiers\for mechanically ventilated adults and children. Cochrane Database Syst Rev 2017;9(9):CD004711. DOI: 10.1002/14651858.CD004711.pub3
Vargas M, Chiumello D, Sutherasan Y, et al. 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. Crit Care 2017;21(1):123. DOI: 10.1186/s13054-017-1710-5
Gaudet A, Martin-Loeches I, Povoa P, et al. Accuracy of the clinical pulmonary infection score to differentiate ventilator-associated tracheobronchitis from ventilator-associated pneumonia. Ann Intensive Care 2020;10(1):101. DOI: 10.1186/s13613-020-00721-4
Moretti M, Van Laethem J, Minini A, et al. Ventilator-associated bacterial pneumonia in coronavirus 2019 disease, a retrospective monocentric cohort study. J Infect Chemother 2021;27(6):826–833. DOI: 10.1016/j.jiac.2021.01.011
Ippolito M, Misseri G, Catalisano G, et al. Ventilator-associated pneumonia in patients with COVID-19: a systematic review and meta-analysis. Antibiotics (Basel) 2021;10(5):545. DOI: 10.3390/antibiotics10050545
Rouyer M, Strazzulla A, Youbong T, et al. Ventilator-associated pneumonia in COVID-19 patients: a retrospective cohort study. Antibiotics (Basel) 2021;10(8):988. DOI: 10.3390/antibiotics10080988
Vacheron CH, Lepape A, Savey A, et al. Increased incidence of ventilator-acquired pneumonia in coronavirus disease 2019 patients: a multicentric cohort study. Crit Care Med 2022;50(3):449–459. DOI: 10.1097/CCM.0000000000005297
Rouzé A, Martin-Loeches I, Povoa P, et al. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study. Intensive Care Med 2021;47(2):188–198. DOI: 10.1007/s00134-020-06323-9
Boyd S, Sheng Loh K, Lynch J, et al. Elevated rates of ventilator-associated pneumonia and COVID-19 associated pulmonary aspergillosis in critically ill patients with SARS-CoV-2 infection in the second wave: a retrospective chart review. Antibiotics (Basel) 2022;11(5):632. DOI: 10.3390/antibiotics11050632