[The effects of active and passive humidification on ventilation-associated nosocomial pneumonia].

STUDY OBJECTIVE: Airway humidification of ventilated patients in an intensive care unit may be established by heated humidifying systems (active) or by the means of a (passive) heat and moisture exchange filter (HMEF). There is a controversial discussion about the influence of the type of humidification on the rate of ventilator-associated pneumonia (VAP). Among 3,585 patients both methods were tested over a period of 21 months in an open, non-randomized cohort study. The aim of the investigation was to compare the incidence of VAP caused by a change of humidification strategy.

METHOD: All patients in a 16-bed surgical intensive care unit who required mechanical ventilation, were included. In the first period (period AB) 1,887 cases were handled with a heated humidifier. During the second period (period PB) 1,698 patients were treated using a HMEF. Infection control was established according to the national Infection Surveillance Program (KISS) based on the CDC criteria for VAP.

RESULTS: During the period of 42 months, 99 cases of VAP were reported. The incidence for VAP was found to be 13.5 (AB) and 9.6 (PB) per 1,000 ventilator days, a rate of 32.3 and 22.4 VAP per 1,000 patients, respectively. The rate of VAP among the groups ( p=0.068) and the incidence of VAP per 1,000 ventilator days ( p=0.089) only just failed to reach a significant level, but in the group of patients requiring mechanical ventilation for more than 2 days, the difference did reach statistical significance ( p=0.012).

CONCLUSION: Our results showed that the rate of VAP could be significantly reduced by changing the strategy from active to passive humidification devices, especially concerning patients requiring long-term respirator therapy. A more physiological humidification and a reduced number of airway manipulations are discussed as a possible explanation.