title: Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients.
abstract: OBJECTIVE
  To measure (1) the discomfort in non-intubated patients under high-flow oxygen therapy (HFOT) humidified with bubble (BH) or heated humidifiers (HH), and (2) the hygrometric properties of oxygen with a BH and an HH.
  
  
  METHODS
  This was a randomized cross-over study in critically ill patients during a 3-day period. The humidification device used at days 1 and 3 was changed for the other at day 2. (2) It was also an experimental bench study using the psychrometric method with five randomized flows (3, 6, 9, 12 and 15 l/min) and different humidification techniques.
  
  
  METHODS
  Discomfort, particularly dryness of the mouth and throat, was measured for two humidification conditions (BH and HH) using a 0-10 numerical rating scale (NRS) by patients requiring HFOT with a face mask at a flow >/=5 l/min, in a double-blinded condition.
  
  
  RESULTS
  (1) In this clinical study, 30 patients treated by HFOT at a median flow of 7.8 l/min (5.1-10.9) were included. The global incidence of moderate (NRS = 4-6) and severe discomfort (NRS = 7-10) was 25 and 29%, respectively. The median intensities of both mouth and throat dryness were significantly lower with the HH than with the BH [7.8 (5.0-9.4) vs. 5.0 (3.1-7.0), P = 0.001 and 5.8 (2.3-8.5) vs. 4.3 (2.0-5.0), P = 0.005, respectively]. (2) In the bench study, the mean absolute humidity measured at an ambient temperature of 26 degrees C with the HH was two times greater than with the BH (30 +/- 1 vs. 16 +/- 2 mg/l, P < 0.05) regardless of the flow rate.
  
  
  CONCLUSIONS
  Compared to bubble humidifiers, the use of a heated-humidifier in patients with high-flow oxygen therapy is associated with a decrease of dryness symptoms mediated by increased humidity delivered to the patient.
authors.affiliation: Intensive Care and Anesthesiology Department B (SAR B), Saint Eloi Hospital. Montpellier University Hospital, 80, Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France. g-chanques@chu-montpellier.fr
authors.forename: Gerald
authors.initials: G
authors.lastname: Chanques
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
authors.forename: Magali
authors.initials: M
authors.lastname: Sauter
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.forename: Mustapha
authors.initials: M
authors.lastname: Sebbane
authors.forename: Daniel
authors.initials: D
authors.lastname: Verzilli
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lefrant
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
mesh_terms: D000368:Aged; D003422:Critical Care; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D006813:Humidity / Q000009:adverse effects*; D007440:Intubation; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects*; D010146:Pain; D012131:Respiratory Insufficiency / Q000628:therapy