{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T06:14:42Z","timestamp":1778652882796,"version":"3.51.4"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Heat and moisture exchanger filters (HMEFs) provide passive humidification and microbial filtration during pediatric anesthesia, but their apparatus dead space and flow resistance\u2014trivial in adults\u2014may represent a clinically important fraction of tidal volume in infants. Progressive moisture saturation further increases resistance, and simultaneous use with an active heated humidifier can precipitate circuit occlusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 13-month-old boy undergoing ophthalmologic surgery developed wheezing, progressively rising peak inspiratory pressure (PIP), and hypercapnia (PaCO\n                      <jats:sub>2<\/jats:sub>\n                      81.5\u2005mmHg) after a difficult intubation. Presumed bronchospasm was treated with salbutamol, sevoflurane escalation, epinephrine, hydrocortisone, and magnesium, producing only partial improvement. He was transferred intubated to the ICU with the same breathing circuit and HMEF\n                      <jats:italic>in situ<\/jats:italic>\n                      . Within approximately 10\u2005min of connection to a ventilator equipped with active heated humidification, PIP rose to 40\u2005cmH\n                      <jats:sub>2<\/jats:sub>\n                      O, delivered tidal volume fell from 90\u2005mL to 50\u2005mL, and PaCO\n                      <jats:sub>2<\/jats:sub>\n                      rose to 119.5\u2005mmHg. The HMEF was visibly saturated; its immediate removal produced prompt resolution of pressure, volume, wheeze, and blood gases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An unremoved HMEF exposed to active heated humidification can cause fulminant ventilatory failure in infants. HMEF dead space, saturation status, and humidifier compatibility must be explicitly verified before and during every pediatric perioperative transfer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1837176","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T05:55:31Z","timestamp":1778651731000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ventilatory failure following active humidification of a retained HMEF in an intubated infant: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Hengjing","family":"Zou","sequence":"first","affiliation":[{"name":"Center of Anesthesiology and Surgery, Chengdu Integrated TCM&Western Medicine Hospital","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guangyi","family":"Lai","sequence":"additional","affiliation":[{"name":"Center of Anesthesiology and Surgery, Chengdu Integrated TCM&Western Medicine Hospital","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanping","family":"Lu","sequence":"additional","affiliation":[{"name":"Center of Anesthesiology and Surgery, Chengdu Integrated TCM&Western Medicine Hospital","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shan","family":"Ou","sequence":"additional","affiliation":[{"name":"Center of Anesthesiology and Surgery, Chengdu Integrated TCM&Western Medicine Hospital","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1111\/j.1365-2044.2010.06564.x","article-title":"Heat and moisture exchangers and breathing system filters: their use in anaesthesia and intensive care. 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