Relative humidity, not absolute humidity, is of great importance when using a humidifier with a heating wire

OBJECTIVES Since the introduction of a humidifier with a heating wire, we have frequently experienced severe upper airway obstruction from consolidation of secretions, previously unencountered when a humidifier without a heating wire was used. Such problems led to the suspicion that the heating wire incorporated into the breathing circuit of the heated humidifier might be the cause. Therefore, we scheduled an experiment to assess the hypothesis that relative humidity, rather than absolute humidity, is a dominant factor in the case of drying secretions in the upper airway when using such a humidifier. DESIGN Three clinical case reports and an experiment with a tracheal model. SETTING Intensive care units at Saitama Medical Center, Saitama Medical School, Saitama, Japan. PATIENTS Three intubated patients. MEASUREMENTS AND MAIN RESULTS An experiment with a tracheal model showed that gas with a higher temperature and lower relative humidity (35 degrees C, 48%) deprived the tracheal model of significantly more water (5.9 +/- 0.2 [SD] g) than gas with a lower temperature and higher relative humidity (24 degrees C, 87%) (2.9 +/- 0.4 g; p less than .01), even though the gases contained the same amount of water vapor (19 mg H2O/L) minus the same absolute humidity. CONCLUSIONS A heated humidifier with a heating wire incorporated into the breathing circuit may be dangerous when only temperature is monitored and controlled. Relative humidity, rather than absolute humidity, is a dominant factor in the case of drying secretions in the upper airway when using such a humidifier.