Influence of breathing resistance of heat and moisture exchangers on tracheal climate and breathing pattern in laryngectomized individuals

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

doi:10.1002/hed.21293

Cited by 19 publications

(32 citation statements)

References 25 publications

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“…2), because this is the average tidal breathing volume previously reported for laryngectomized patients. 12 For each of the tested HMEs, the water exchange at the breathing volume of 0.5 L can be found in Table 2. The water exchange capacity ranged from 0.5 to 3.6 mg.…”

Section: Resultsmentioning

confidence: 99%

“…The functional core material traps and releases a small amount of water during exhalation and inhalation, respectively. With different types of HMEs currently available, the literature is growing rapidly on the effect of HMEs on clinical complaints, 4-9 influence on respiratory function, 2,[10][11][12] in vivo humidity measurements, [13][14][15] and comparison of in vitro measurements. 16,17 However, no comparative data have been published as yet on the performance of the whole range of HMEs available for laryngectomized patients today.…”

Section: Introductionmentioning

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: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

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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“…These values are summarized in Table 2, together with the differences relative to the Provox Normal. Values at 0.5 L were required for comparison with the previously reported in vivo measurements in patients, with an average breathing volume of 0.5 L. 20 For comparison with the ISO standard, weight changes at a volume of 1.0 L were required.…”

Section: Resultsmentioning

confidence: 99%

A Novel, Simplified Ex Vivo Method for Measuring Water Exchange Performance of Heat and Moisture Exchangers for Tracheostomy Application

Boer

Müller²,

Vincent

et al. 2013

Respir Care

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BACKGROUND: Breathing through a tracheostomy results in insufficient warming and humidification of inspired air. This loss of air-conditioning can be partially compensated for with the application of a heat and moisture exchanger (HME) over the tracheostomy. In vitro (International Organization for Standardization [ISO] standard 9360 -2:2001) and in vivo measurements of the effects of an HME are complex and technically challenging. The aim of this study was to develop a simple method to measure the ex vivo HME performance comparable with previous in vitro and in vivo results. METHODS: HMEs were weighed at the end of inspiration and at the end of expiration at different breathing volumes. Four HMEs (Atos Medical, Hörby, Sweden) with known in vivo humidity and in vitro water loss values were tested. The associations between weight change, volume, and absolute humidity were determined using both linear and non-linear mixed effects models. RESULTS: The rating between the 4 HMEs by weighing correlated with previous intratracheal measurements (R 2 ‫؍‬ 0.98), and the ISO standard (R 2 ‫؍‬ 0.77). CONCLUSIONS: Assessment of the weight change between end of inhalation and end of exhalation is a valid and simple method of measuring the water exchange performance of an HME.

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“…We compared Provox Normal (which has well known heat and moisture exchanging capacity) [19][20][21] and Stomvent (an older model HME with a different design), to Rplus (which has a normal breathing resistance) and Lplus (which has a lower breathing resistance, comparable to that of the Provox HiFlow, which we did not test in this study). 20 We considered the Provox Normal the reference HME.…”

Section: Heat and Moisture Exchangersmentioning

confidence: 99%

“…20 We considered the Provox Normal the reference HME. Table 1 shows the in vitro moisture loss and pressure drop, according to ISO9360-2;2001.…”

Section: Heat and Moisture Exchangersmentioning

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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Influence of breathing resistance of heat and moisture exchangers on tracheal climate and breathing pattern in laryngectomized individuals

Cited by 19 publications

References 25 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 Novel, Simplified Ex Vivo Method for Measuring Water Exchange Performance of Heat and Moisture Exchangers for Tracheostomy Application

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

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