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Effectiveness of heat and moisture exchangers in preventing ventilator-associated pneumonia in critically ill patients: a meta-analysis.

Menegueti MG, Auxiliadora-Martins M, Nunes AA - BMC Anesthesiol (2014)

Bottom Line: Comparison between the use of HME and HH did not reveal any differences in terms of VAP occurrence (OR = 0.998; 95% CI: 0.778-1.281).The use of HME and HH did not afford different results in terms of mortality (OR = 1.09; 95% CI: 0.864-1.376).Current meta-analysis was not sufficient to definitely exclude an associate between heat and moisture exchangers and VAP.

View Article: PubMed Central - PubMed

Affiliation: Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP Brazil ; Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, Divisão de Terapia Intensiva, Departamento de Cirurgia e Anatomia - 2o andar, Av. Bandeirantes, 3900 - Bairro Monte Alegre, Ribeirão Preto, SP Brazil.

ABSTRACT

Background: Patients may acquire ventilator-associated pneumonia (VAP) by aspirating the condensate that originates in the ventilator circuit upon use of a conventional humidifier. The bacteria that colonize the patients themselves can proliferate in the condensate and then return to the airways and lungs when the patient aspirates this contaminated material. Therefore, the use of HME might contribute to preventing pneumonia and lowering the VAP incidence. The aim of this study was to evaluate how the use of HME impacts the probability of VAP occurrence in critically ill patients.

Methods: On the basis of the acronym "PICO" (Patient, Intervention, Comparison, Outcome), the question that guided this review was "Do critically ill patients under invasive mechanical ventilation present lower VAP incidence when they use HME as compared with HH?". Two of the authors of this review searched the databases PUBMED/Medline, The Cochrane Library, and Latin-American and Caribbean Literature in Health Sciences, LILACS independently; they used the following keywords: "heat and moisture exchanger", AND "heated humidifier", AND "ventilator-associated pneumonia prevention". This review included papers in the English language published from January 1990 to December 2012.

Results: This review included ten studies. Comparison between the use of HME and HH did not reveal any differences in terms of VAP occurrence (OR = 0.998; 95% CI: 0.778-1.281). Together, the ten studies corresponded to a total sample of 1077 and 953 patients in the HME and HH groups, respectively; heterogeneity among the investigations was low (I(2) < 50%). Information about the outcome mortality was available in only eight of the ten studies. The use of HME and HH did not afford different results in terms of mortality (OR = 1.09; 95% CI: 0.864-1.376). The total sample size was 884 and 762 patients, respectively. Heterogeneity among the studies was low (I(2) = 0.0%).

Conclusion: Current meta-analysis was not sufficient to definitely exclude an associate between heat and moisture exchangers and VAP. Despite the methodological limitations found in selected clinical trials, the current meta-analysis suggests that HME does not decrease VAP incidence or mortality in critically ill patients.

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Related in: MedlinePlus

Synthesis of the results considering mortality in eight of the ten studies. Meta-analysis containing Forest plot and Odds Ratio values of each study and summarized Odds Ratio by the fixed effects model with their respective 95% CI; beyond the value of Q and I2 tests, considering HME (A) and HH (B).
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Fig3: Synthesis of the results considering mortality in eight of the ten studies. Meta-analysis containing Forest plot and Odds Ratio values of each study and summarized Odds Ratio by the fixed effects model with their respective 95% CI; beyond the value of Q and I2 tests, considering HME (A) and HH (B).

Mentions: Comparison between the use of HME and HH, in this meta-analysis did not reveal any differences in terms of VAP occurrence (OR = 0.998; 95% CI: 0.778–1.281). Together, the ten studies corresponded to a total sample of 1077 and 953 patients in the HME and HH groups, respectively; heterogeneity among the investigations was low (I2 < 50%).Information about the outcome mortality was available in only eight of the ten studies. Hence, the results synthesis can be seen in the referent meta-analysis (Figure 3).Figure 3


Effectiveness of heat and moisture exchangers in preventing ventilator-associated pneumonia in critically ill patients: a meta-analysis.

Menegueti MG, Auxiliadora-Martins M, Nunes AA - BMC Anesthesiol (2014)

Synthesis of the results considering mortality in eight of the ten studies. Meta-analysis containing Forest plot and Odds Ratio values of each study and summarized Odds Ratio by the fixed effects model with their respective 95% CI; beyond the value of Q and I2 tests, considering HME (A) and HH (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4384307&req=5

Fig3: Synthesis of the results considering mortality in eight of the ten studies. Meta-analysis containing Forest plot and Odds Ratio values of each study and summarized Odds Ratio by the fixed effects model with their respective 95% CI; beyond the value of Q and I2 tests, considering HME (A) and HH (B).
Mentions: Comparison between the use of HME and HH, in this meta-analysis did not reveal any differences in terms of VAP occurrence (OR = 0.998; 95% CI: 0.778–1.281). Together, the ten studies corresponded to a total sample of 1077 and 953 patients in the HME and HH groups, respectively; heterogeneity among the investigations was low (I2 < 50%).Information about the outcome mortality was available in only eight of the ten studies. Hence, the results synthesis can be seen in the referent meta-analysis (Figure 3).Figure 3

Bottom Line: Comparison between the use of HME and HH did not reveal any differences in terms of VAP occurrence (OR = 0.998; 95% CI: 0.778-1.281).The use of HME and HH did not afford different results in terms of mortality (OR = 1.09; 95% CI: 0.864-1.376).Current meta-analysis was not sufficient to definitely exclude an associate between heat and moisture exchangers and VAP.

View Article: PubMed Central - PubMed

Affiliation: Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP Brazil ; Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, Divisão de Terapia Intensiva, Departamento de Cirurgia e Anatomia - 2o andar, Av. Bandeirantes, 3900 - Bairro Monte Alegre, Ribeirão Preto, SP Brazil.

ABSTRACT

Background: Patients may acquire ventilator-associated pneumonia (VAP) by aspirating the condensate that originates in the ventilator circuit upon use of a conventional humidifier. The bacteria that colonize the patients themselves can proliferate in the condensate and then return to the airways and lungs when the patient aspirates this contaminated material. Therefore, the use of HME might contribute to preventing pneumonia and lowering the VAP incidence. The aim of this study was to evaluate how the use of HME impacts the probability of VAP occurrence in critically ill patients.

Methods: On the basis of the acronym "PICO" (Patient, Intervention, Comparison, Outcome), the question that guided this review was "Do critically ill patients under invasive mechanical ventilation present lower VAP incidence when they use HME as compared with HH?". Two of the authors of this review searched the databases PUBMED/Medline, The Cochrane Library, and Latin-American and Caribbean Literature in Health Sciences, LILACS independently; they used the following keywords: "heat and moisture exchanger", AND "heated humidifier", AND "ventilator-associated pneumonia prevention". This review included papers in the English language published from January 1990 to December 2012.

Results: This review included ten studies. Comparison between the use of HME and HH did not reveal any differences in terms of VAP occurrence (OR = 0.998; 95% CI: 0.778-1.281). Together, the ten studies corresponded to a total sample of 1077 and 953 patients in the HME and HH groups, respectively; heterogeneity among the investigations was low (I(2) < 50%). Information about the outcome mortality was available in only eight of the ten studies. The use of HME and HH did not afford different results in terms of mortality (OR = 1.09; 95% CI: 0.864-1.376). The total sample size was 884 and 762 patients, respectively. Heterogeneity among the studies was low (I(2) = 0.0%).

Conclusion: Current meta-analysis was not sufficient to definitely exclude an associate between heat and moisture exchangers and VAP. Despite the methodological limitations found in selected clinical trials, the current meta-analysis suggests that HME does not decrease VAP incidence or mortality in critically ill patients.

Show MeSH
Related in: MedlinePlus