Heat and moisture exchange capacity of the upper respiratory tract and the effect of tracheotomy breathing on endotracheal climate

Scheenstra, Renske J.; Müller, Sara; Vincent, Andrew; Hilgers, Frans J. M.

doi:10.1002/hed.21408

Cited by 12 publications

(12 citation statements)

References 29 publications

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“…In both situations, the expired air is almost completely saturated with water, but the saturation is more complete in the volunteer (99% RH vs 92% RH). 29,30 The use of a laryngectomized patient might have slightly influenced the absolute results, but the relative ordering of the HMEs would not be different, as can also been seen in Figure 7, where the results of this study are compared with actual in vivo observations. This ex vivo method enables an HME comparison study without performing measurements clinically in laryngectomized patients, which with 23 different HMEs would be a near impossible undertaking.…”

Section: Discussionmentioning

confidence: 63%

“…13,30,[33][34][35] The physiological tracheal climate during nose breathing is known for healthy volunteers and for head and neck cancer patients with a temporary tracheotomy. 29,30 As laryngectomized patients are head and neck cancer patients, the subglottic humidity value during nose breathing in this patient group (29.3 mg/L at 1 cm behind the temporary tracheostoma) 30 can be considered the target humidity value in the upper trachea of laryngectomized patients. In Figure 8 (available in the supplementary materials at http://www.rcjournal.com), the HMEs tested are placed in order of their AH insp values next to the target AH insp value of nose breathing (all values are standardized to a reference ambient humidity of 5 mg/L).…”

Section: Discussionmentioning

confidence: 99%

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Ex Vivo Assessment and Validation of Water Exchange Performance of 23 Heat and Moisture Exchangers for Laryngectomized Patients

Boer¹,

Müller²,

Vincent

et al. 2013

Respir Care

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BACKGROUND: Breathing through a tracheostoma results in insufficient warming and humidification of the inspired air. This loss of air conditioning, especially humidification, can be partially restored with the application of a heat and moisture exchanger (HME) over the tracheostoma. For medical professionals, it is not easy to judge differences in water exchange performance of various HMEs owing to the lack of universal outcome measures. This study has three aims: assessment of the water exchange performance of commercially available HMEs for laryngectomized patients, validation of these results with absolute humidity outcomes, and assessment of the role of hygroscopic salt present in some of the tested HMEs. METHODS: Measurements of weight and absolute humidity at end inspiration and end expiration at different breathing volumes of a healthy volunteer were performed using a microbalance and humidity sensor. Twenty-three HMEs from 6 different manufacturers were tested. Associations were determined between core weight, weight change, breathing volume, and absolute humidity, using both linear and nonlinear mixed effects models. RESULTS: Water exchange of the 23 HMEs at a breathing volume of 0.5 L varies between 0.5 and 3.6 mg. Both water exchange and wet core weight correlate strongly with the end-inspiratory absolute humidity values (r 2 ‫؍‬ 0.89/0.87). Hygroscopic salt increases core weight. CONCLUSIONS: The 23 tested HMEs for laryngectomized patients show wide variation in water exchange performance. Water exchange correlates well with the end-inspiratory absolute humidity outcome, which validates the ex vivo weight change method. Wet core weight is a predictor of HME performance. Hygroscopic salt increases the weight of the core material. The results of this study can help medical professionals to obtain a more founded opinion about the performance of available HMEs for pulmonary rehabilitation in laryngectomized patients, and allow them to make an informed decision about which HME type to use.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Ex Vivo Assessment and Validation of Water Exchange Performance of 23 Heat and Moisture Exchangers for Laryngectomized Patients

Boer¹,

Müller²,

Vincent

et al. 2013

Respir Care

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“…Although Rplus and Lplus have important improvements over Provox Normal, they still do not provide the subglottic temperature and humidity achieved by the upper airways during nasal or oral breathing in young and healthy volunteers or in head and neck cancer patients. 12 The question arises of what further modifications would improve HME performance, considering the limited space available in an HME for laryngectomized patients. Additional (identical) core material would either increase the resistance or create an unacceptably bulky HME.…”

Section: Discussionmentioning

confidence: 99%

“…10 However, regular HME use does not always eliminate pulmonary complaints, possibly because the HME is not a full-fledged substitute for the upper airways and does not provide the physiologic endotracheal temperature and humidity attained in normal individuals. [11][12][13] Heating and humidification by an HME is based on the condensation of expired moisture on the HME's core material (foam or paper impregnated with a hygroscopic salt such as calcium chloride). One of the limiting factors in HME design for laryngectomized patients is the HME's size, which should be small enough for the patient to wear comfortably.…”

Section: Introductionmentioning

confidence: 99%

A New Heat And Moisture Exchanger for Laryngectomized Patients: Endotracheal Temperature and Humidity

et al. 2011

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OBJECTIVE: To assess the endotracheal temperature and humidity and clinical effects of 2 models of a new heat and moisture exchanger (HME): Rplus, which has regular breathing resistance, and Lplus, which has lower breathing resistance. METHODS: We measured endotracheal temperature and humidity in 10 laryngectomized patients, for 10 min each, with and without the HMEs. We sequentially tested 4 HME models (all Atos Medical, Hörby, Sweden), in randomized order: Rplus, Lplus, Provox Normal (the HME we regularly use and which we considered the reference HME), and Stomvent (an older HME model). We also assessed the short-term clinical and practical effects of the Rplus and Lplus in a prospective 3-week trial with 13 laryngectomized patients. RESULTS: Rplus and Lplus had better humidification than Provox Normal (6.8 mg H 2 O/L, 4.3 mg H 2 O/L, and 3.7 mg H 2 O/L, respectively, P < .001), and no significant temperature difference. During the 3-week study period, 7 of the 13 patients reported noticeably lower mucus production with Rplus and Lplus. CONCLUSIONS: Rplus and Lplus had better heating and humidification than Provox Normal. Although Stomvent also performed well, its design is less convenient for laryngectomized patients. Further HME improvement is still warranted and should focus on improving the HME's heating capacity.

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“…Clinical and physiology research has shown that the short-circuiting of the upper respiratory tract has significant consequences for the pulmonary system. 46 For instance, during normal nasal breathing in living-room conditions (22 o C, and 40% relative humidity, which equals an absolute water content of 8mg H 2 O/L), air-temperature at the subglottic level has increased to 32 o C, and humidity has quadrupled to 35-36mg H 2 O/L. In the alveoli, temperature is 37 o C and relative humidity 100% (an absolute humidity of 44mg H 2 O/L).…”

Section: Pulmonary Rehabilitationmentioning

confidence: 99%

Practice of laryngectomy rehabilitation interventions

Molen

Kornman

Latenstein

et al. 2013

Current Opinion in Otolaryngology & Head and Neck Surgery

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General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. 2 AbstractPurpose of Review Total laryngectomy rehabilitation (TLR) in Europe is not uniform, with quite some differences in approach and infrastructure between the various countries. In e.g. the Netherlands, Switzerland, Scandinavia, and more recently also in the UK, Head and Neck Cancer treatment and rehabilitation shows a high level of centralisation in dedicated HNC centres. In other European countries, the level of centralisation is lower, with more patients treated in lowvolume hospitals. This paper focuses on the situation in the Netherlands, and where applicable, will discuss regional variations in Europe.Recent Findings Prosthetic surgical voice restoration (PSVR) presently is method of choice in Europe, and use of oesophageal and electrolarynx voice has moved to the background. In most European countries (except UK and Ireland), PSVR is physician driven, with an indispensable role for Speech Language Pathologists, and increasingly for oncology nurses. Indwelling voice prostheses are mostly preferred, also because these devices can be implanted at the time of tracheaoesophageal puncture. Pulmonary rehabilitation is achieved with heat and moisture exchangers, which, based on extensive clinical and basic physiology research, are considered an obligatory therapy measure. Besides PSVR, also issues such as smoking cessation, dysphagia/swallowing rehabilitation, and olfaction/taste rehabilitation are discussed. Especially the latter has shown great progress over the last decade, and is another example of increasing implementation of evidence-based practice in TLR.Summary TLR has shown considerable progress over the last decades, and through the intensified collaboration between all clinicians involved, significantly has improved vocal, pulmonary, and olfactory rehabilitation after TL. KeywordsTotal laryngectomy; voice rehabilitation; pulmonary rehabilitation; olfactory rehabilitation; swallowing rehabilitation; multidisciplinary approach Bullet list  Prosthetic Surgical Voice Restoration is the method of choice for re-establishing postlaryngectomy oral communication, ensuring early regain of optimal voice and speech quality  As with any surgical method, adverse events have to be taken into account, but clinica...

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Heat and moisture exchange capacity of the upper respiratory tract and the effect of tracheotomy breathing on endotracheal climate

Abstract: This study gives objective information about the HME capacity of the upper respiratory tract in patients with head and neck cancer with precautionary tracheotomy, and thus provides target values for HMEs for laryngectomized and tracheotomized patients.

Cited by 12 publications

References 29 publications

Ex Vivo Assessment and Validation of Water Exchange Performance of 23 Heat and Moisture Exchangers for Laryngectomized Patients

Ex Vivo Assessment and Validation of Water Exchange Performance of 23 Heat and Moisture Exchangers for Laryngectomized Patients

A New Heat And Moisture Exchanger for Laryngectomized Patients: Endotracheal Temperature and Humidity

Practice of laryngectomy rehabilitation interventions

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