Chest
Volume 93, Issue 2, February 1988, Pages 289-293
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Clinical Investigations
Subjective Effects of Humidification of Oxygen for Delivery By Nasal Cannula: A Prospective Study

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Humification of oxygen prior to administration by nasal cannula is an expensive practice which has been justified on the basis that it improves the comfort of patients receiving supplemental oxygen therapy. Routine humidification of low-flow oxygen (≤4 L/min) delivered by nasal cannula has recently been challenged based on theoretic grounds and on the results of a clinical study. Nevertheless, we found, in a telephone survey of medium-sized American hospitals, that routine humidification of nasal cannula oxygen remains a common practice. To further evaluate the necessity of oxygen humidification, we prospectively evaluated, on a daily basis, the subjective complaints of consecutive patients in our institution who were ordered to receive nasal oxygen at relatively high flow rates (5 L/min). Of the 185 patients evaluated over a period of three wintertime months, 99 received humidified oxygen and 86 received dry oxygen. Complaints, especially dry nose and dry throat (42.9 percent and 43.9 percent of the daily interviews, respectively) were common in both groups, but the symptoms were relatively mild and did not increase significantly when oxygen was administered without prior humidification. We conclude that routine humidification of oxygen for administration by nasal cannula is not justifiable, and that cessation of this practice would result in significant reductions in both time and material costs in respiratory care.

Section snippets

Hospital Survey

Hospitals listed in the American Hospital Association Guide to Hospitals9 as having between 575 and 625 beds were contacted by telephone. The director of the hospital's respiratory therapy department, or other knowledgable individual in the department, was asked about departmental policies for humidification of oxygen for delivery by nasal cannula. In those departments in which oxygen was not routinely humidified for all such patients, departmental criteria for selection of patients to receive

Hospital Survey

The results of the telephone survey are presented in Table 2. There was wide variability in the policies for routine oxygen humidification. In nearly half of the hospitals surveyed, all patients received humidified nasal oxygen, and only three hospitals did not routinely humidify nasal oxygen for at least some patients. Twenty-five of the 30 hospitals in which oxygen was not routinely humidified cited recent evidence indicating lack of justification.5, 6

Patient Complaints

Figure 1 shows complaints, by type, of

DISCUSSION

The results of our telephone survey indicated that respiratory therapy departments in medium-sized American hospitals vary widely with regard to their policies for routine humidification of nasal oxygen. Of 55 hospitals surveyed, nearly half humidified oxygen for all patients and most of the remainder delivered humidified oxygen to patients receiving oxygen flow rates in excess of 2-4 L/min. Only three surveyed hospitals did not routinely humidify nasal cannula oxygen at all. By the nature of

ACKNOWLEDGMENTS

The authors wish to thank Dennis Gelgut, R.R.T., for assisting with the hospital survey, Alexander Scott Kennedy for computer data input, and Phyllis Burch, C.R.T.T., for medical records research. We also appreciate the suggestions of Dr. R. M. Senior during the preparation of this manuscript.

REFERENCES (23)

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    Supported in part by USPHS Grant No. HL30341 and by The Council for Tobacco Research, U.S.A., Inc.

    Manuscript received June 1; revision accepted July 17.

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