{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T03:27:22Z","timestamp":1787887642497,"version":"build-2784847793"},"reference-count":36,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Background:<\/jats:title>\n \n Heat and moisture exchangers (HMEs) preserve airway humidification in mechanically ventilated subjects. However, the additional instrumental dead-space (V\n D<\/jats:sub>\n ) may impair carbon dioxide (CO\n 2<\/jats:sub>\n ) elimination and require an increase mechanical power (MP), both associated with higher risk of ventilator-induced lung injury. The physiological effects (P\n \n aCO\n 2<\/jats:sub>\n <\/jats:sub>\n and MP) of HME use and instrumental V\n D<\/jats:sub>\n compensation strategies have not been comprehensively evaluated. We sought to\u00a0evaluate the impact of HMEs on arterial CO\n 2<\/jats:sub>\n and MP in intubated subjects undergoing controlled mechanical ventilation, and to compare the effect of compensation strategies\u2014tidal volume (V\n T<\/jats:sub>\n ) or breathing frequency (f)\u2014on CO\n 2<\/jats:sub>\n and MP.\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n Prospective crossover study including intubated adults receiving controlled mechanical ventilation. We evaluated 4 conditions. (1) HME, (2) no HME, (3) HME + high V\n T<\/jats:sub>\n , (4) HME + high f. Main outcomes were P\n \n aCO\n 2<\/jats:sub>\n <\/jats:sub>\n and MP.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Adding the HME increased P\n \n aCO\n 2<\/jats:sub>\n <\/jats:sub>\n and ventilatory ratio and reduced arterial pH (\n P<\/jats:italic>\n < .001). When V\n T<\/jats:sub>\n or f was increased to compensate for the HME-associated V\n D<\/jats:sub>\n , the P\n \n aCO\n 2<\/jats:sub>\n <\/jats:sub>\n decreased (\n P<\/jats:italic>\n < .001) but the MP increased (\n P<\/jats:italic>\n < .001), mainly because of its resistive component. A compensation strategy based on higher V\n T<\/jats:sub>\n was more effective in restoring P\n \n aCO\n 2<\/jats:sub>\n <\/jats:sub>\n to baseline levels than increasing f (\n P<\/jats:italic>\n = .035); however, increasing V\n T<\/jats:sub>\n augmented the global and elastic MP (\n P<\/jats:italic>\n < .001 and\n P<\/jats:italic>\n = .002, respectively).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n The HME impaired\u00a0CO\n 2<\/jats:sub>\n elimination. Increasing V\n T<\/jats:sub>\n or f to compensate for the HME-associated V\n D<\/jats:sub>\n increased MP. At an equivalent minute ventilation, increasing V\n T<\/jats:sub>\n was more effective for CO\n 2<\/jats:sub>\n clearance but may compromise lung protection. Under iso-CO\n 2<\/jats:sub>\n conditions, the strategies did not differ.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/19433654261427702","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T10:08:41Z","timestamp":1773828521000},"page":"723-732","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of Heat-Moisture Exchangers and Dead Space Compensation on CO\n 2<\/sub>\n Clearance and Mechanical Power in Critically Ill Intubated Subjects"],"prefix":"10.1177","volume":"71","author":[{"given":"Javier H.","family":"Dorado","sequence":"first","affiliation":[{"name":"Mr. Dorado, Mr. Perez, Mr. Steinberg, Bertozzi, and Accoce are aff\u00edliated with Division of Physical Therapy and Respiratory Care, Intensive Care Unit, Sanatorio Anchorena San Mart\u00edn, Buenos Aires, Argentina."},{"name":"Mr. Dorado is aff\u00edliated with Division of Physical Therapy and Respiratory Care, Rehabilitation Department, Intensive Care Unit, Hospital de Gastroenterolog\u00eda Dr. Carlos Bonorino Udaondo, Buenos Aires, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaqu\u00edn","family":"Perez","sequence":"additional","affiliation":[{"name":"Mr. Dorado, Mr. Perez, Mr. Steinberg, Bertozzi, and Accoce are aff\u00edliated with Division of Physical Therapy and Respiratory Care, Intensive Care Unit, Sanatorio Anchorena San Mart\u00edn, Buenos Aires, Argentina."},{"name":"Mr. Perez and Mr. Steinberg are aff\u00edliated with Hospital Carlos G. Durand, Buenos Aires, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dami\u00e1n","family":"Steinberg","sequence":"additional","affiliation":[{"name":"Mr. Dorado, Mr. Perez, Mr. Steinberg, Bertozzi, and Accoce are aff\u00edliated with Division of Physical Therapy and Respiratory Care, Intensive Care Unit, Sanatorio Anchorena San Mart\u00edn, Buenos Aires, Argentina."},{"name":"Mr. Perez and Mr. Steinberg are aff\u00edliated with Hospital Carlos G. Durand, Buenos Aires, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo A.","family":"Plotnikow","sequence":"additional","affiliation":[{"name":"Mr. Plotnikow is aff\u00edliated with Division of Physical Therapy and Respiratory Care, Rehabilitation Department, Intensive Care Unit, Hospital Brit\u00e1nico de Buenos Aires, Buenos Aires, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mat\u00edas","family":"Bertozzi","sequence":"additional","affiliation":[{"name":"Mr. Dorado, Mr. Perez, Mr. Steinberg, Bertozzi, and Accoce are aff\u00edliated with Division of Physical Therapy and Respiratory Care, Intensive Care Unit, Sanatorio Anchorena San Mart\u00edn, Buenos Aires, Argentina."},{"name":"Mr. Bertozzi is aff\u00edliated with Hospital Donaci\u00f3n Francisco Santojanni, Buenos Aires, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mat\u00edas","family":"Accoce","sequence":"additional","affiliation":[{"name":"Mr. Dorado, Mr. Perez, Mr. Steinberg, Bertozzi, and Accoce are aff\u00edliated with Division of Physical Therapy and Respiratory Care, Intensive Care Unit, Sanatorio Anchorena San Mart\u00edn, Buenos Aires, Argentina."},{"name":"Mr. Accoce is aff\u00edliated with Burns Hospital, Ciudad Aut\u00f3noma de Buenos Aires, Argentina."},{"name":"Mr. Accoce is aff\u00edliated with Facultad de Medicina y Ciencias de la Salud, Universidad Abierta Interamericana, Ciudad Aut\u00f3noma de Buenos Aires, 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