title: Impact of the humidification device on intubation rate during noninvasive ventilation with ICU ventilators: results of a multicenter randomized controlled trial.
abstract: OBJECTIVE
  The use of heat and moisture exchangers (HME) during noninvasive ventilation (NIV) can increase the work of breathing, decrease alveolar ventilation, and deliver less humidity in comparison with heated humidifiers (HH). We tested the hypothesis that the use of HH during NIV with ICU ventilators for patients with acute respiratory failure would decrease the rate of intubation (primary endpoint) as compared with HME.
  
  
  METHODS
  We conducted a multicenter randomized controlled study in 15 centers. After stratification by center and type of respiratory failure (hypoxemic or hypercapnic), eligible patients were randomized to receive NIV with HH or HME.
  
  
  RESULTS
  Of the 247 patients included, 128 patients were allocated to the HME group and 119 to the HH group. Patients were comparable at baseline. The intubation rate was not significantly different: 29.7% in the HME group and 36.9% in the HH group (p = 0.28). PaCO2 did not significantly differ between the two arms, even in the subgroup of hypercapnic patients. No significant difference was observed for NIV duration, ICU and hospital LOS, or ICU mortality (HME 14.1 vs. HH 21.5%, p = 0.18).
  
  
  CONCLUSIONS
  In this study, the short-term physiological benefits of HH in comparison with HME during NIV with ICU ventilators were not observed, and no difference in intubation rate was found. The physiologic effects may have been obscured by leaks or other important factors in the clinical settings. This study does not support the recent recommendation favoring the use of HH during NIV with ICU ventilators.
authors.affiliation: Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France. francois.lellouche@criucpq.ulaval.ca.|Service de Soins Intensifs, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec, G1V4G5, Canada. francois.lellouche@criucpq.ulaval.ca.
authors.forename: François
authors.initials: F
authors.lastname: Lellouche
authors.affiliation: Service de Réanimation Médicale, Hôpital de la Cavale Blanche, Brest, France.
authors.forename: E
authors.initials: E
authors.lastname: L'Her
authors.affiliation: Service de Réanimation Médicale, Hôpital Bourguiba, Monastir, Tunisia.
authors.forename: F
authors.initials: F
authors.lastname: Abroug
authors.affiliation: Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Deye
authors.affiliation: Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France.|Servicio de Terapia Intensiva y Neumonología, CEMIC (Centro de Educación Médica e Investigaciones Clínicas), Buenos Aires, Argentina.
authors.forename: P O
authors.initials: PO
authors.lastname: Rodriguez
authors.affiliation: Service de Réanimation Médicale, Hôtel Dieu, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Rabbat
authors.affiliation: Service de Réanimation Chirurgicale, Hôpital Saint Eloi, Montpellier, France.
authors.forename: S
authors.initials: S
authors.lastname: Jaber
authors.affiliation: Service de Réanimation Médicale, Hôpital Tenon, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Fartoukh
authors.affiliation: Istituto di anestesiologia e Rianimazione, Università Cattolica Policlinico A. Gemelli, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Conti
authors.affiliation: Service de Réanimation Médicale, Hôpital de la Pitié Salpétrière, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Cracco
authors.affiliation: Service de Réanimation Médicale, CHU de Rouen, Rouen, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Richard
authors.affiliation: Service de Réanimation Médicale, Hôpital Louis Mourier, Colombes, France.
authors.forename: J D
authors.initials: JD
authors.lastname: Ricard
authors.affiliation: Service de Réanimation Médicale, Hôpital Beaujon, Clichy, France.
authors.forename: H
authors.initials: H
authors.lastname: Mal
authors.affiliation: Service de Réanimation Médicale, Hôpital Victor Dupouy, Argenteuil, France.
authors.forename: H
authors.initials: H
authors.lastname: Mentec
authors.affiliation: Service de Soins Intensifs, Hôpital de l'Enfant Jésus, Québec, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Loisel
authors.affiliation: Service de Réanimation Médicale, Centre hospitalier intercommunal, Poissy, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Lacherade
authors.affiliation: Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France.
authors.forename: S
authors.initials: S
authors.lastname: Taillé
authors.affiliation: Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France.
authors.forename: L
authors.initials: L
authors.lastname: Brochard
mesh_terms: D000368:Aged; D005260:Female; D006358:Hot Temperature; D006801:Humans; D006813:Humidity; D007362:Intensive Care Units; D007440:Intubation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000295:instrumentation*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000628:therapy*; D012122:Ventilators, Mechanical