HYDRATION, HUMIDIFICATION and NEBULISATION
AARC (2012) Guideline update: humidification during invasive and noninvasive mechanical ventilation. Respir Care; 57(5):782-8
• compared to hot water humidification, HME’s increase dead space and reduce CO2 clearance

AARC Clinical Practice Guideline: BLAND AEROSOL ADMINISTRATION (2003). Respir Care; 48, 529-33
www.rcjournal.com/cpgs/05.03.0529.html
• US guidelines on saline nebulisers

AARC Clinical Practice Guideline: DIRECTED COUGH (1993). Respir Care, 38, 5, 495–9
www.rcjournal.com/cpgs/dccpg.html
• similar to ACBT


Al Ashry HS, Modrykamien AM (2014) Humidification during mechanical ventilation in the adult patient. Biomed Res Int; 2014:715434. doi: 10.1155/2014/715434

Anil AB, Anil M, Saglam AB (2010) High volume normal saline alone is as effective as nebulized salbutamol-normal saline, epinephrine-normal saline, and 3% saline in mild bronchiolitis. Pediatr Pulmonol, 45, 1, 41-47

Branson RD (2009) Conditioning inspired gases: the search for relevant physiologic end points. Respir Care, 54, 4, 450-2
www.rcjournal.com/contents/04.09/04.09.0450.pdf
• HME is associated with risk of ETT obstruction 4 x that of heated humidifier.
• choice of humidifier should be based on gas exchange, not moisture output.

Brusasco C (2013) In vitro evaluation of heat and moisture exchangers designed for spontaneously breathing tracheostomized patients. Respir Care; 58(11):1878-85

Chanques G, Constantin JM, Sauter M (2009) Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients. Int Care Med,35(6):996–1003.

Chikata Y, Oto J, Onodera M et al (2013) Humidification performance of humidifying devices for tracheostomized patients with spontaneous breathing: a bench study. Respir Care, 58(9):1442-8
• a heat-moisture exchanger is inadequate in the acute stage of tracheostomy, especially if oxygen is added

Chiumello D (2008) Effect of a heated humidifier during continuous positive airway pressure delivered by a helmet. Crit Care, 12: R55
ccforum.com/content/12/2/R55
• humidification is required with a helmet

Desbrow B, Jansen S, Barrett A et al (2014) Comparing the rehydration potential of different milk-based drinks to a carbohydrate-electrolyte beverage. Appl Physiol Nutr Metab; 39(12):1366-72. doi: 10.1139/apnm-2014-0174
• milk is more effective for rehydration than sports drinks

Foreman A, De Santis RJ, Sultanov F et al (2016) Heat and moisture exchanger use reduces in-hospital complications following total laryngectomy: a case-control study. J Otolaryngol Head Neck Surg; 45(1):40
www.ncbi.nlm.nih.gov/pmc/articles/PMC4936316/

Franchini ML, Athanazio R, Amato-Lourenço LF et al (2016) Oxygen with cold bubble humidification is no better than dry oxygen in preventing mucus dehydration, decreased mucociliary clearance, and decline in pulmonary function. Chest; 150(2):407-14. doi: 10.1016/j.chest.2016.03.035

Ida Y, Ohnishi H, Araki K et al (2016) Efficient management and maintenance of ultrasonic nebulizers to prevent microbial contamination. World J Methodology; 6(1):126-132. doi: 10.5662/wjm.v6.i1.126.
www.ncbi.nlm.nih.gov/pmc/articles/PMC4804248/#B4

Jadhav S, Sahasrabudhe T, Kalley V et al (2013) The microbial colonization profile of respiratory devices and the significance of the role of disinfection: a blinded study. J Clin Diagn Res; 7(6):1021-6. doi: 10.7860/JCDR/2013/5681.3086

Jiang M, Song JJ, Guo XL et al (2015) Airway humidification reduces the inflammatory response during mechanical ventilation. Respir Care; 60(12):1720-8. doi: 10.4187/respcare.03640
• hot water humidifiers appear to inhibit inflammatory damage to lung tissue caused by mechanical ventilation

Kelly M, Gillies D, Todd DA, Lockwood C. Heated humidification versus heat and moisture exchangers for ventilated adults and children. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD004711. DOI: 10.1002/14651858.CD004711.pub2.

Lellouche F, Qader S, Taillé S et al (2014) Short-term effects of humidification devices on respiratory pattern and arterial blood gases during noninvasive ventilation. Respir Care; 59(5):637-43. doi: 10.4187/respcare.02523

Lonie S, Baker P, Teixeira R (2016) Steam vaporizers: a danger for paediatric burns. Burns; 42(8):1850-1853. doi: 10.1016/j.burns.2016.05.009

Mandelberg M (2010) Hypertonic saline or high volume normal saline for viral bronchiolitis: mechanisms and rationale. Pediatr Pulmonol, 45, 1, 36-40
• the watery sol layer must be 7 μm thick for the cilia tips to reach the mucus

Oto J, Nakataki E, Okuda N et al (2014) Hygrometric properties of inspired gas and oral dryness in patients with acute respiratory failure during noninvasive ventilation. Respir Care; 59(1):39-45. doi: 10.4187/respcare.02351

Solomita M (2009) Humidification and secretion volume in mechanically ventilated patients. Respir Care, 54, 10,
www.rcjournal.com/contents/10.09/10.09.1329.pdf

Sommer JU (2013) Functional short- and long-term effects of nasal CPAP with and without humidification on the ciliary function of the nasal respiratory epithelium. Sleep Breath; 18(1):85-93. doi: 10.1007/s11325-013-0853-0

Soudorn C, Muntham D, Reutrakul S et al (2016) Effect of heated humidification on CPAP therapy adherence in subjects with obstructive sleep apnea with nasopharyngeal symptoms. Respir Care; 61(9):1151-1159

Towle D, Callan DA, Lamprea C et al (2016) Baby bottle steam sterilizers for disinfecting home nebulizers inoculated with non-tuberculous mycobacteria. J Hosp Infect; 92(3):222-5. doi: 10.1016/j.jhin.2015.08.030

Tucci MR, Costa EL (2015) Humidification during invasive mechanical ventilation: less lung inflammation with optimal gas conditioning. Respir Care; 60(12):1854-5. doi: 10.4187/respcare.04512

Wang J, Pi H (2016) Effects of two different methods for airway humidification for patients with tracheostomy: a Meta-analysis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue;28(1):63-9. doi: 10.3760/cma.j.issn.2095-4352.2016.01.012



AARC = American Association for Respiratory Care.
ACBT = active cycle of breathing techniques
HME = heat-moisture exchanger
QoL = quality of life