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Another report of obstruction of a heat and moisture exchange filter

Garran, Australia

To the Editor:

I wish to congratulate Drs. Williams and Stacey on their report describing occlusion of a Pall heat and moisture exchange filter (HMEF) by pulmonary edema.¹ I would like to report a similar incident involving a Pall BB25S HMEF.

A 54-yr-old, previously well man was undergoing debridement of a leg injury. The patient had been fasting since the time of his injury, 36 hr previously. The anesthetic and procedure were uneventful until emergence, when the patient regurgitated a small amount of bile-stained fluid into the laryngeal mask. The fluid reached the HMEF, but it was not obviously heavily contaminated.

The patient developed signs of airway obstruction and auscultation revealed widespread inspiratory and expiratory rhonchi and coarse crepitations. The patient was treated for bronchospasm secondary to aspiration of gastric contents. There was no response to nebulized salbutamol, and the patient was then intubated because of increasing airway obstruction. Aliquots of adrenaline, 50–100 µg, were given intravenously without effect, to a total of 400 µg.

The breathing circuit was then tested, and the HMEF was found to be occluded. The HMEF was changed and resolution of all obstruction occurred. The HMEF was examined. It was not obviously contaminated, but some regions of the HMEF were a faint yellow colour. The affected HMEF weighed 1 g more than a new filter. The patient did not sustain any long-term sequelae, and did not require any special care apart from supplementary oxygen for 12 hr.

Reference

1 Williams DJ, Stacey MRW. Rapid and complete occlusion of a heat and moisture exchange filter by pulmonary edema (Clinical report). Can J Anesth 2002; 49: 126–31.[Abstract/Free Full Text]

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