We investigated the effects of the properties of heat and moisture exchangers on airway pressure. We interconnected an artificial lung, artificial sputum injection port, heat and moisture exchanger, hose and artificial respirator, and used a differential manometer to measure differences in pressure between each end of the heat and moisture exchanger and pressure at the anesthesia patient-side of the heat and moisture exchanger (compared with atmospheric pressure). Based on these results, we calculated the pressure on the patient-side of the heat and moisture exchanger. Measurements were taken prior to injection of artificial sputum and at the point of positive end-expiratory pressure immediately after injection of from 1 to 12 mL of artificial sputum, increasing at 1-mL intervals. Heat and moisture exchangers were the 'Pharma HME 10' and 'Pharma Mini' (Pharma Systems, Knivsta, Sweden), while 2% methyl cellulose (Wako Pure Chemical Industries, Osaka, Japan) (1500 mPa-s) was used as artificial sputum.
With the Pharma Mini (heat and moisture exchanger in combination with bacterial filtration), pressure tended to increase with injection of more than 4 mL artificial sputum. Pressure at both the anesthesia apparatus- and patient-sides of the heat and moisture exchanger increased significantly following the 5 mL injection, after which pressure increased with increased injection volume. No change in pressure with artificial sputum injection was observed for the Pharma HME 10 (heat and moisture exchanger).
The user manual for heat and moisture exchangers states that the device should be immediately replaced if secretions accumulate. However, this warning is given for all types of heat and moisture exchangers and disregards the considerable structural differences in heat and moisture exchangers. Provision of more detailed information regarding patients safety is needed from the manufacturers these devices.
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