Heat and moisture exchanger cassettes: Results of a quality/safety initiative to reduce postoperative mucus plugging after total laryngectomy

Abstract

Background Tracheal dryness is a concern after total laryngectomy due to the potential for mucus plugs (MP). This study compared heat and moisture exchanger (HME) cassettes to external tracheal humidification (ETH) surrounding MP events. Methods A retrospective comparative cohort study comparing outcomes before/after implementation of a patient safety initiative utilizing HME during post laryngectomy hospitalization. The number of MP events were compared with a pre‐implementation control group using ETH. Patient characteristics were analyzed for correlation with MP. Results The rate of MP was significantly lower in the HME group than ETH (0.13 and 0.38 per 10 inpatient days, respectively, P = .02). The proportion of patients with one or more MP events was also significantly reduced in the HME group (50% ETH and 11% HME, P = .01). Method of humidification was the only significant variable associated with MP on logistic regression modeling (P = .008). Conclusions HMEs were superior to ETH for prevention of MP.

The use of tracheostoma humidification by people with total laryngectomy in the UK: a cross-sectional survey.

“…Our findings show that the majority of PTL (69%) included in the audit used a closed-system HME. While this is a lower proportion than has been quoted in previous studies 5 , HME usage varied across centres from 28% to 95%. The centre with the largest number of cases also reported the highest HME use, while many of those centres with lower HME use also reported higher levels of missing data.…”

“…While closed system HMEs are more expensive than alternative stoma covers 3 , the benefits are well recognised including reduced coughing, shortness of breath, mucous production, plug formation and chest infections 5,6,7 . There is a correlation between duration of HME use and pulmonary benefit 8 .…”

“…Despite evidence of efficacy, variable compliance rates with HME use have been reported, from 35% to 83% 10,5 . Reported reasons for resistance to HME use include excessive mucus production, blockage of the filter and poor baseplate seal 6 .…”

New Heat and Moisture Exchangers for Laryngectomized Patients in Germany: Mixed Methods Study on the Expected Effectiveness

“…In total, 3 (30%) randomized controlled trials [ 28 , 29 , 40 ], 3 (30%) time-series studies in which patients acted as their own controls [ 31 , 41 , 42 ], 1 (10%) retrospective comparative cohort study [ 43 ], 1 (10%) retrospective clinical and survey study [ 12 ], 1 (10%) multigroup design study (study design was not reported by the authors themselves) [ 16 ], and 1 (10%) case-control study [ 44 ] were included. The new generation of HMEs were compared with a control (no HME use) [ 12 , 16 , 28 , 39 - 41 ], an external humidifier [ 29 , 43 , 44 ], or a previous generation HME [ 31 ]. The studies were performed in 7 different countries, namely the United States [ 16 , 43 ], Canada [ 44 ], France [ 29 , 40 ], Italy [ 41 , 42 ], Spain [ 31 ], the Netherlands [ 12 ], and Poland [ 28 ].…”

“…The new generation of HMEs were compared with a control (no HME use) [ 12 , 16 , 28 , 39 - 41 ], an external humidifier [ 29 , 43 , 44 ], or a previous generation HME [ 31 ]. The studies were performed in 7 different countries, namely the United States [ 16 , 43 ], Canada [ 44 ], France [ 29 , 40 ], Italy [ 41 , 42 ], Spain [ 31 ], the Netherlands [ 12 ], and Poland [ 28 ]. The studies included a total of 550 patients, with a minimum of 30 patients [ 41 , 42 ] and a maximum of 89 patients [ 12 ].…”