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Vol. 45. Issue 6.
Pages 354-361 (August - September 2021)
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Vol. 45. Issue 6.
Pages 354-361 (August - September 2021)
DOI: 10.1016/j.medine.2019.11.008
Active humidification in mechanical ventilation is not associated to an increase in respiratory infectious complications in a quasi-experimental pre–post intervention study
La humidificación activa en ventilación mecánica no se asocia con un aumento de complicaciones infecciosas respiratorias en un estudio cuasi-experimental pre-postintervención
L. Picazoa,b, M.P. Gracia Arnillasa,b, R. Muñoz-Bermúdeza,b, X. Duránb, F. Álvarez Lermaa,b,c, J.R. Masclansa,b,c,
Corresponding author

Corresponding author.
a Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain
b Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
c Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Figures (1)
Tables (4)
Table 1. Baseline characteristics of the study population.
Table 2. Incidence density of invasive mechanical ventilation associated respiratory infection.
Table 3. Logistic regression analysis of risk factors of VAP and VAT.
Table 4. Respiratory sample isolates in VAP.
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There is controversy regarding the influence of humidification systems upon the incidence of respiratory infections associated to invasive mechanical ventilation (IMV). An evaluation was made of the differences in the incidence of pneumonia and tracheobronchitis associated to mechanical ventilation (VAP and VAT, respectively) with passive and active humidification.


A retrospective pre–post quasi-experimental study was carried out.


A polyvalent ICU with 14 beds.


All patients connected to IMV for >48h during 2014 and 2016 were included.


During 2014, passive humidification with an hygroscopic heat and moisture exchanger (HME) was used, while during 2016 active humidification with a heated humidifier (HH) and an inspiratory heated wire was used. Identical measures for the prevention of VAP were established (Zero Pneumonia Project).

Main outcome measures

The incidence of VAP and VAT was estimated for 1000 days of IMV in both groups, and statistically significant differences were assessed using Poisson regression analysis.


A total of 287 patients were included (116 with HME and 171 with HH). The incidence density of VAP per 1000 days of IMV was 5.68 in the HME group and 5.80 in the HH group (p=ns). The incidence density of VAT was 3.41 and 3.26 cases per 1000 days of VMI with HME and HH respectively (p=ns). The duration of IMV was identified as a risk factor for VAP.


In our population, active humidification in patients ventilated for >48h was not associated to an increase in respiratory infectious complications.

Active humidification
Hygroscopic heat and moisture exchange
Invasive mechanical ventilation
Ventilator associated pneumonia (VAP)
Ventilator associated tracheobronquitis (VAT)
Respiratory infection

Existen controversias sobre la influencia del sistema de humidificación en la incidencia de infecciones respiratorias asociadas a la ventilación mecánica invasiva (VMI). Nuestro objetivo fue evaluar las diferencias en la incidencia de neumonía y traqueobronquitis asociadas a la ventilación mecánica (NAV y TAV respectivamente) con humidificación pasiva y activa.


Estudio retrospectivo cuasi-experimental de tipo pre-postintervención.


UCI polivalente de 14 camas.


Se incluyeron todos los pacientes conectados a la VMI durante>48horas durante los años 2014 y 2016.


Durante el año 2014 se empleaba humidificación pasiva con un intercambiador calor-humedad (HME) y, durante 2016, humidificación activa (HH) con calentamiento de la tubuladura inspiratoria. Se establecieron medidas idénticas para la prevención de NAV (proyecto Neumonía Zero).

Variables de interés principales

Se estimaron tasas de incidencia NAV y TAV por 1.000 días de VMI en ambos grupos y se valoraron diferencias estadísticamente significativas mediante regresión Poisson.


Se incluyeron 287 pacientes (116 con HME y 171 con HH). La densidad de incidencia de NAV por 1.000 días de VMI fue de 5,68 en el grupo de HME y 5,80 en el grupo de HH (p=ns). La densidad de incidencia de TAV fue 3,41 y 3,26 casos por 1.000 días de VMI con HME y HH respectivamente (p=ns). Se identificó como factor de riesgo de NAV la duración de la VMI.


En nuestro estudio la humidificación activa en pacientes ventilados durante>48horas no se asoció con un aumento de las complicaciones infecciosas respiratorias.

Palabras clave:
Humidificación activa
Intercambiador calor-humedad
Ventilación mecánica invasiva
Neumonía asociada a la ventilación (NAV)
Traqueobronquitis asociada a la ventilación (TAV)
Infección respiratoria


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