Pulmonale Rehabilitation nach totaler Laryngektomie durch die Verwendung von HME (Heat Moisture Exchanger)

Abstract

A complete removal of the larynx has profound consequences for a patient. Since laryngectomy involves the separation of the upper airway from the lower airway, it not only implies a loss of the voice organ but also leads to chronic lung problems such as increased coughing, mucus production and expectoration. In addition, laryngectomees complain of fatigue, sleeping problems, a reduced sense of smell and taste, and a loss of social contact. A heat and moisture exchanger (HME) cassette can replace a function of the upper airway which consists in conditioning inspired air. It can improve pulmonary symptoms in three ways. 1. An HME cassette heats and moisturises inhaled air and thus creates nearly physiological conditions in the region of the deep airway. 2. The use of an HME cassette leads to an increase in breathing resistance, thereby reducing dynamic airway compression and improving lung ventilation. 3. An HME cassette acts as a filter and removes larger particles from incoming air. This review examines the current understanding of lung physiology after laryngectomy and assesses the effects of HME cassettes on the conditioning of respiratory air, lung function and psychosocial problems.

The challenges of treating tracheobronchitis in a laryngectomee due to nontypeable Haemophilus influenzae: a case report

“…The stoma in neck breathers allows the inhaled air to bypass the natural defenses (nasal hair and mucus membranes) of the upper airway that filter out dust and bacteria. Wearing an HME that covers the stoma can provide important benefits [ 1 , 2 ]. The HME filter serves as a stoma cover and creates a tight seal around the stoma.…”

“…Laryngectomees run a high risk of developing severe respiratory tract infections. Following laryngectomy the tracheal epithelium becomes directly exposed to the relatively cold and dry ambient air entering the tracheostoma [ 1 , 2 ]. This can cause: drying of the mucus, which makes it more viscous; reduction of ciliary activity that causes impaired mucociliary clearance [ 2 – 4 ]; and tracheal epithelium damage (loss of ciliated cells, goblet cell hyperplasia, and excessive mucus production and metaplasia) [ 4 ].…”

In Vitro Evaluation of Heat and Moisture Exchangers Designed for Spontaneously Breathing Tracheostomized Patients

“…RESPIRATORY CARE • NOVEMBER 2013 VOL 58 NO 11measurements were recorded at 0, 6, 12, and 24 h; resistance and weight of the HME were recorded at 0 and 24 h. Flow resistance was estimated from the pressure drop across the HME at 60 L/min flow. HME weight was measured by a precision balance, and the absolute change for each HME was determined.…”

“…[8][9][10] The use of HMEs in chronically tracheostomized spontaneously breathing patients can reduce retained secretions and improve quality of life. 11,12 HMEs can also provide supplemental oxygen (O 2 ) flow through a direct connection to an O 2 delivery system. However, a dry and cold gas flow directly on the HME's membrane might reduce the amount of water and heat retained and transferred by the HME.…”

Larinks ve akciğer maligniteli olgularda akciğer rezeksiyonu

“…Grup 2'de yer alan trakeostomili hastalara kuvvetli öksürme, balon şişirme ve spirometre kullanımı gibi rutin uygulamaları gerçekleştiremedikleri için sık aspirasyon yapılarak sekresyon kontrolü sağlanmaya çalışılsa da, iki hastada bronkoskopi gerekli olmuştur. Bu sorun ile ilgili yapılan çalışmalar incelendiğinde, standart spirometri cihazının trakeostomili hastalar için yapılmış modifiye bir halini kullanımını öneren çalışmalar olduğu gibi, hastanın öksürmesini sağlayan devreler ve solunum havasının ısı ve nemini düzenleyen cihazların kullanımını öneren çalışmalar da mevcuttur (9,(17)(18)(19).…”