A study of the effect of a resistive heat moisture exchanger (trachinaze) on pulmonary function and blood gas tensions in patients who have undergone a laryngectomy: A randomized control trial of 50 patients studied over a 6‐month period

Jones, A. S.; Young, Pam; Hanafi, Z.; Makura, Zorustra George Grange; Fenton, J. E.; Hughes, Joseph P.

doi:10.1002/hed.10264

Cited by 43 publications

(52 citation statements)

References 15 publications

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“…Consequently, patients develop pulmonary problems such as mucus hypersecretion and frequent involuntary coughing, and become more susceptible to respiratory infections. 2,3 Also, breathing through a temporary tracheostomy results in insufficient warming and humidification of inspired air. Compensation for the loss of air-conditioning can be achieved by application of a heat and moisture exchanger (HME) over the tracheostoma.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…The first-generation HMEs used corrugated paper as the core material, and regular HME use significantly reduced pulmonary complaints and improved quality of life. [6][7][8] Subsequent-generation HMEs were developed, initially to improve patient adherence to therapy, by making the HME easily replaceable and independent of the peristomal fixation adhesive, 9 and to improve the tracheostoma digital occlusion port that allows phonation. 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.…”

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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“…47 Clinical research has shown that these HMEs significantly reduce pulmonary side effects of TL, such as involuntary coughing, excessive phlegm production, and forced expectoration for clearing the trachea from mucous. [48][49][50][51][52] In parallel with the improved pulmonary status, a significant improvement in several quality of life aspects, and also in voice quality has been demonstrated. 53 HMEs obviously should be applied 24/7, irrespective of voice rehabilitation method.…”

Section: Pulmonary Rehabilitationmentioning

confidence: 99%

“…Again, the fact that these devices all have proven their efficacy in prospective clinical trials has been quite helpful to achieve this. 55 Cost-effectiveness studies are currently underway, and although results are not in yet, it is expected that these studies will show a relatively low cost per QALY, because of gain in QoL, and of reduction of pulmonary infections, 50 lowering need for antibiotics. An interesting thought in this respect is that the well-known wintertime trachea-bronchitis with often severe, sometimes even life-threatening crusting is a disease of the past in the Netherlands.…”

Section: Economic Aspectsmentioning

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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A study of the effect of a resistive heat moisture exchanger (trachinaze) on pulmonary function and blood gas tensions in patients who have undergone a laryngectomy: A randomized control trial of 50 patients studied over a 6‐month period

Abstract: Trachinaze is highly superior to placebo at improving subjective pulmonary parameters, including shortness of breath. It is also superior in its ability to maintain an increased peripheral tissue oxygen tension over a 6-month period.

Cited by 43 publications

References 15 publications

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

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

Practice of laryngectomy rehabilitation interventions

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