Heat and moisture exchangers (HMEs) are used as a normal treatment for respiratory reintegration after a total laryngectomy. Usually, the upper airways state (heat and humify) the gasped air, but in laryngectomy patients, the lungs are unprotected from the dehydrated and cold air during open stoma breathing. An HME supplied by HME Filter Suppliers shielding the stoma can to some degree recovers the pulmonary condition. The advantages of HME use have been underscored in many studies; it does not only recover pulmonary functioning, such as a reduction in mucus manufacture, coughing, and instinctive expectorations but also the psychosocial running of laryngectomies patients. Laryngectomized patients are suggested to unceasingly use an HME with the highest conceivable humidification performance (the highest water exchange). 

The humidification performance of the HME, and thus its advantages, relies primarily on the HME core material and cartridge design. The HME core material often comprises a porous polymer foam saturated with hygroscopic salt, which acts as a concentration and vanishing surface. Since the HME is a submissive humidifier, its humidification performance can mainly be improved by snowballing the width and height of the core material or declining the foam’s aperture size. The surge of width and height is restricted by aesthetic considerations. Moreover, these performance improvements have a trade-off with the HME’s breathing confrontation and therefore patient receipt. To cater to the different patient requirements and activity levels, multiple types of HMEs have been industrialized, which differ in resistance and performance. Nonetheless, complete HME acquiescence has not yet been attained in all laryngectomy patients. Laryngectomized patients stop their (high humidification presentation) HME use due to the higher breathing confrontation of the HME compared to open stoma breathing, particularly occasionally during physical activities. Although physical exercise can sometimes be expected, changing between different HME kinds with varying breathing resistance is not always an option or needs added effort and preparation. As a consequence, some patients do not consume any HME at all.

Patient obedience and comfort during different levels of physical actions could potentially be enhanced by providing one HME machine that allows a rapid and simple alteration of the breathing resistance based on the patient’s activity level. During the respite, a laryngectomee patient can use the HME machine with a higher resistance and humidification performance location. On the other hand, during physical actions, the HME device can be attuned to cut its resistance, while upholding an apt humidification performance.

Historical expansion

Heat and moisture exchangers became accessible with HME Filter Dealers in the 1950s after the presentation of tracheostomy for easing mechanical ventilation of the lungs. In his report of the polio outbreak in Denmark in 1952, Lassen stated that when using the method of tracheostomy and positive-pressure artificial ventilation, a good humidifier is vital: otherwise, incrustation of oozes may occur’.

Planes of moisture during normal breathing

When inspired gas is warmed, moistened, and transported to the patient, the temperature and moisture of the gas must be close to the levels found in the patient’s airways during standard breathing. For instance, if the patient’s trachea is intubated, the gas transported at the end of the tracheal tube must have the same temperature and moisture as inspired air during normal breathing at that level.

How is it used in a total laryngectomy?

During a total laryngectomy, the complete voicebox (larynx) is removed, which leads to a permanent cessation of the upper and lower airways and a perpetual tracheostomy (a breathing cavity in the neck). Before the operation, breathing mainly happens through the nasal airways. In the upper airways, the gasped air is warmed up or chilled down, to prepare the ideal temperature before the air grasps the lungs. After a total laryngectomy, the upper airways are sidestepped, and breathing in and out happens through the tracheostomy in the neck which necessitates that the gasped air streams directly into the lungs. These functional changes lead, among others, to variations in voice construction, breathing, and olfaction. The nasal purposes of standardizing the temperature, moistening, and sifting of the inhaled air are lost. The absence of these functions damages the lower airways and the action of the cilia, which leads to respiratory glitches such as tracheobronchial mucus, extreme mucus production, and crusting, which can also cause exhaustion and shortness of breath. To at least partly decrease these limitations and recompense the nasal functions, an HME cartridge can be committed over the tracheostomy to provide a means for acclimatizing, moistening, and to a certain degree sifting the inhaled air.

Advantages of HMEs

Alternative humidification must be provided directly post-operatively as well as in long-standing use. The use of HME machines supplied by HME Filter Suppliers has proven to be operative in refining obedience with humidification distribution, reducing coughing and forced expectoration as well as refining sleeping and patient gratification. HMEs have also been exposed to decrease in-hospital collations, including mucous plugging. Other advantages are abridged secretions; though it may take time to observe a change in oozes. 

Consequences of a randomized controlled study of lasting use showed that with HME there was a noteworthy reduction in the frequency of coughing, forced expectoration, and stoma scrubbing when compared to a control group

HMEs upsurge the resistance to gasped air and may take some time to get used to, mainly if the HME was not used directly after surgery. 

Some HMEs offer less endurance and greater airflow, which can be helpful during exercise or strenuous activity.

Talking with an HME

There are hand-free HMEs that permit talking without the necessity to physically press on the HME as well as HME for cardinal obstruction. 

An HME with a talking valve has been revealed to surge the all-out phonation time and deliver a suggestively larger dynamic range.

Humidification Bib

Some patients favor using humidification bibs over HME machines. 

A Buchannon bib shelters the stoma and is another way of moistening gasped gases. These come in a diversity of styles and designs and can camouflage the stoma from view.

Dangers produced by insufficient humidity

When the upper airways are sidestepped and gas with insufficient humidity is transported directly to the trachea, damage can happen to the lining of the trachea. In actuality, insufficient humidity can reason dysfunction of the mucociliary elevator, which includes respiratory cilia lining the trachea and functions by stirring liquid and mucus toward the larynx.

Summary

Anatomical changes post-laryngectomy consequence in a loss of the humidification properties of the upper airway. Patients with laryngectomy advantage from substitute humidification such as HMEs which can deliver many benefits including plummeting oozes, reduced secretion plugs, abridged coughing, and abridged stoma cleaning. A multi-disciplinary team can play a noteworthy role in patient consequences.