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Respir Care. 2014 Jan;59(1):46-53. doi: 10.4187/respcare.02214. Epub 2013 Jun 13.

Heated humidification improves clinical outcomes, compared to a heat and moisture exchanger in children with tracheostomies.

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Department of Paediatrics, Child and Youth Health, University of Auckland, and with Starship Children's Hospital, Grafton, Auckland, New Zealand.



The upper airway humidifies and warms inspired gases before they reach the trachea, a process bypassed by the insertion of a tracheostomy, necessitating humidification of inspired gases. The optimal method of humidification is not known.


We conducted a short-term 20-hour study and a long-term 10-week randomized crossover study comparing a heated humidifier (HH) to a heat and moisture exchanger (HME) in children with established tracheostomies. Subjects were assessed for clinical events, clinical examination findings, airway cytokine levels, and airway secretion viscoelasticity.


For the short-term study, 15 children were recruited; for the long-term study, 14 children were recruited. Children using the HH had decreased respiratory examination score (P < .001) but no change in clinical events over the short term. There was a decrease in acute clinical events (P = .008) in the long-term study. No differences were found in airway secretion viscoelasticity results or cytokine levels in either study, but these sample numbers were limited.


Over 20 hours use, HH, compared to HME, improved work of breathing. Over a longer 10 week treatment period HH resulted in decreased adverse clinical events.


child; humidity; inflammation; mucociliary clearance; randomized controlled trial; rheology; tracheostomy

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