Comprehensive structural model for the evaluation of HME humidification properties

Abstract

Abstract HMEs (heat and moisture exchangers) are employed in clinical practice to humidify the inspired air in intubated patients. We aimed to develop and experimentally validate a mass based model describing the water input-output equilibrium in the presence of HMEs. The model should serve as a universally applicable basis for the evaluation of the fundamental HME humidification properties performance (mg reversibly stored per breath) and efficiency. A plug flow model was designed using three different locations (gas inlet, moisture benefit and water output) for inspiratory-expiratory flow and humidity measurements. We developed a complete set of algorithms for the calculation of all relevant metrics. Measurements also assessed humidity dependent volume changes. We proved the concept through the validation of humidity predictions without HME in the test setup at target humidities of 37 and 44 mg/l respectively with the inspiratory volume of 0.25, 0.50 and 0.75 l. The concept was applied in the evaluation of a random sample of HMEs. Differences between prediction and measurements ranged between − 1.89 and 2.24 mg/l. For moisture benefit a mean difference of 0.15 mg/l (sd 0.69) was found and for water output of -0.48 mg/l (sd 0.98). Humidification caused a significant volume increase up to 6.6% with respect to the inspired dry air. HME performance results of five HME brands ranged from 5 to 30 mg overall. Performance results derived from moisture benefit and water output agreed within 5% of the common mean. Efficiency results can be above 80% over the whole measurement range or below 20% at high water load depending on the HME brand. Thus, HMEs can be sorted by registering efficiency at the upper bound of the tidal volume range. HMEs for laryngectomized patients (LE-HMEs) showed much lower performances between 2 and 5 mg per breath due to their small size. A novel comprehensive research environment, both theoretical and experimental, enables the assessment of HME properties and gives qualitative and quantitative definitions of HME performance and efficiency for clinical use.