{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T09:54:08Z","timestamp":1775469248895,"version":"3.50.1"},"reference-count":13,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2017,5,1]],"date-time":"2017-05-01T00:00:00Z","timestamp":1493596800000},"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":["Respir Care"],"published-print":{"date-parts":[[2017,5]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Many in vitro models report higher inhaled dose with dry versus heated humidity. Heat-and-moisture exchangers (HMEs) provide passive humidity in ventilator-dependent patients but act as a barrier to aerosol. The HMEs designed to allow aerosol delivery (HME-ADs) have not been well described. The purpose of this study is to determine the impact on aerosol deposition of HME-ADs with and without active exhaled humidity in a simulated ventilator-dependent adult model.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n \n We used an in vitro lung model consisting of an intubated teaching mannequin with an endotracheal tube of 8.0 mm inner diameter with bronchi directly attached to a collecting filter and passive rubber test lung to provide testing without active exhaled humidity. To simulate exhaled humidity, a Cascade humidifier (37\u00b0C and 100% relative humidity) was placed between the collecting filter and test lung, simulating body temperature and pressure saturated exhaled humidity at the bronchi. Albuterol sulfate (2.5 mg\/3 mL) was administered with a mesh nebulizer (Aerogen Solo) placed in the inspiratory limb of the ventilator circuit at the Y-piece, with no HME in place (control) and with 3 HME-AD devices, including the CircuVent, Humid-Flo, and AirLife, with and without exhaled humidity. Drug was eluted from the collecting filter and analyzed with spectrophotometry. Student\n t<\/jats:italic>\n tests and analysis of variance were used for data analysis (\n P<\/jats:italic>\n < .05).\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n The percentage of drug dose delivered (mean \u00b1 SD) distal to the bronchi in the control experiments was greater than all of the HME-ADs without exhaled humidity 18 \u00b1 0.7 and with active exhaled humidity 10.8 \u00b1 0.2% (\n P<\/jats:italic>\n < .005). Without exhaled humidity, aerosol delivery with the CircuVent (12.6 \u00b1 0.8), Humid-Flo (15.3 \u00b1 0.8), and AirLife (12.0 \u00b1 0.5) was less than control (\n P<\/jats:italic>\n < .001,\n P<\/jats:italic>\n = .01 and\n P<\/jats:italic>\n < .001, respectively). In contrast, with exhaled humidity, no difference was found between control and HME-ADs (\n P<\/jats:italic>\n = .89). Also, a greater variation between control and the 3 HME-ADs was observed without exhaled humidity. Drug delivery without exhaled humidity exceeded aerosol deposition obtained with exhaled humidity in all conditions tested in this study.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n In this model simulating active exhaled humidity, aerosol drug delivery was lower and more consistent with both control and the HME-ADs than with the standard nonhumidified model. Further studies are needed to determine whether greater deposition in a dry model is an artifact of the model that does not simulate exhaled humidity.<\/jats:p>\n <\/jats:sec>","DOI":"10.4187\/respcare.05015","type":"journal-article","created":{"date-parts":[[2017,3,7]],"date-time":"2017-03-07T20:40:20Z","timestamp":1488919220000},"page":"538-543","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":22,"title":["Effects of Heat and Moisture Exchangers and Exhaled Humidity on Aerosol Deposition in a Simulated Ventilator-Dependent Adult Lung Model"],"prefix":"10.1177","volume":"62","author":[{"given":"Arzu","family":"Ari","sequence":"first","affiliation":[{"name":"Department of Respiratory Therapy, Georgia State University, Atlanta, Georgia 30302-4019."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid S","family":"Alwadeai","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy, Georgia State University, Atlanta, Georgia 30302-4019."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James B","family":"Fink","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy, Georgia State University, Atlanta, Georgia 30302-4019."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2017,5,1]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.01766"},{"key":"e_1_3_2_3_2","unstructured":"International Organization for Standardization. Heat and moisture exchangers for use in humidifying respired gases in humans (ISO 9360). Geneva: International Organization for Standardization; 1992."},{"key":"e_1_3_2_4_2","unstructured":"Respiratory tract humidifiers for medical use\u2014particular requirements for respiratory humidification systems. ISO 8185: 2007. https:\/\/www.iso.org\/obp\/ui\/#iso:std:iso:8185:ed-3:v2:en. Accessed November 1 2016."},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200201000-00033"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200005000-00026"},{"issue":"8","key":"e_1_3_2_7_2","first-page":"93","article-title":"Use of heat and moisture exchanging (HME) filters in mechanically ventilated ICU patients: influence on airway flow-resistance","volume":"19","author":"Chiaranda M","unstructured":"Chiaranda M, , Verona L, , Pinamonti O, , Dominioni L, , Minoja G, , Conti G. Use of heat and moisture exchanging (HME) filters in mechanically ventilated ICU patients: influence on airway flow-resistance. Intensive Care Med, 19(8)93; 19:462\u2013466.","journal-title":"Intensive Care Med"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2009.04.026"},{"issue":"6","key":"e_1_3_2_9_2","first-page":"758","article-title":"AARC clinical practice guidelines: endotracheal suctioning of mechanically ventilated patients with artificial airways","volume":"55","author":"American Association for Respiratory Care","year":"2010","unstructured":"American Association for Respiratory Care. AARC clinical practice guidelines: endotracheal suctioning of mechanically ventilated patients with artificial airways. Respir Care. 2010; 55(6):758\u2013764.","journal-title":"Respir Care"},{"issue":"4","key":"e_1_3_2_10_2","first-page":"625","article-title":"Contaminated condensate in mechanical ventilator circuits: a risk factor for nosocomial pneumonia","volume":"129","author":"Craven DE","year":"1984","unstructured":"Craven DE, , Goularte TA, , Make BJ. Contaminated condensate in mechanical ventilator circuits: a risk factor for nosocomial pneumonia. Am Rev Respir Dis, 1984; 129(4):625\u2013628.","journal-title":"Am Rev Respir Dis"},{"issue":"5","key":"e_1_3_2_11_2","first-page":"792","article-title":"Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation","volume":"133","author":"Craven D","year":"1986","unstructured":"Craven D, , Kunches LM, , Kilinsky V, , Lichtenberg DA, , Make BJ, , McCabe WR. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis, 1986; 133(5):792\u2013796.","journal-title":"Am Rev Respir Dis"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.10550837"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.161.5.9909032"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.09541336"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.4187\/respcare.05015","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.05015","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.4187\/respcare.05015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T08:55:41Z","timestamp":1775465741000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.4187\/respcare.05015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5]]},"references-count":13,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2017,5]]}},"alternative-id":["10.4187\/respcare.05015"],"URL":"https:\/\/doi.org\/10.4187\/respcare.05015","relation":{},"ISSN":["0020-1324"],"issn-type":[{"value":"0020-1324","type":"print"}],"subject":[],"published":{"date-parts":[[2017,5]]}}}