Incidents and accidents

Ventilation with cold and dry gases is responsible for several complications including hypothermia, water loss, epithelial and ciliary damage, atelectasis, and perturbations in gas exchange leading to hypoxia (Table 1).

In contrast, overhumidification or ventilation with gases that are too hot can cause hyperhydratation, tracheal burns, and atelectasis leading to hypoxia. Incidents and accidents with heat and moisture exchangers

Some HMEs can cause occlusion of the tracheal tube (Ma.rt.i,Q,..e.t.,al, 1990, Mart.iD.. .et... al 1992). This catastrophic event is reported mostly with hydrophobic HMEs. The efficiency of these HMEs is significantly decreased when tidal volume increases, and the great majority of patients who have experienced tube occlusion were submitted to high minute ventilation (10 l/min or more). Water reduction in hydrophobic HMEs is a purely physical phenomenon, and increased tidal volume may reduce their performance compared with hygroscopic HMEs (Rathgeberefal: 1996) Use of an HME does not increase the levels of intrinsic positive end-expiratory pressure and dynamic hyperinflation.

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