Heat and moisture exchanger use reduces in-hospital complications following total laryngectomy: a case–control study

Abstract

BackgroundTotal laryngectomy (TL) is an appropriate oncologic operation for many patients with laryngeal cancer delivering excellent oncologic outcomes, however it remains beset with significant functional consequences. Following TL, the upper and lower airways are permanently disconnected, which causes unfiltered, cold air with reduced humidity to enter the tracheobronchial tree, resulting in mucus overproduction and an increase in the viscosity of the mucus. In response to this, Heat and moisture exchangers were developed to compensate for the lost functions of the upper respiratory tract and their effect on the patients’ respiratory performance in addition to their quality of life.MethodsThe case records of 48 patients undergoing total laryngectomy were reviewed and data concerning demographics, surgical details, post-operative care requirements and adverse events was retrieved. Post hoc analysis of the case patients was undertaken to identify any benefit of using a heat and moisture exchanger (HME) system with particular reference to post-operative respiratory outcomes.ResultsThere was no significant difference between case and control subjects based on demographics, extent of surgery or need for flap repair. 16 patients had used a HME and 32 patients had used external humidification (EH). Of those experiencing mucous plugging, only 3/24 (12.5 %) had used a HME system, in contrast to 21/24 (87.5 %) who used EH (Chi square = 9.375, p = 0.002). The odds ratio of having an adverse event if not using HME was 8.27 (CI = 1.94 – 35.71). Use of HME also significantly reduced the number of days requiring physiotherapy (1.75 days vs. 3.20 days, p = 0.034).ConclusionUse of an HME system can reduce in-hospital complications, in particular episodes of mucus plugging, and post-operative care requirements. Furthermore, there is a cost benefit to using HME systems that warrants more widespread introduction of these devices in head and neck surgery centers.

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

“…Previous studies have reported similar rates of daily cassette change and a cost benefit to using HMEs over ETH. 19,20 In this report, few barriers were identified to immediate and consistent use of an HME, with the majority of patients initiating HME use on POD 1. HME cassettes continue to be used (in lieu of ETH) for postoperative pulmonary rehabilitation at our organization.…”

“…Only one other study has compared the effect of ETH and HMEs on MP, with findings consistent with this report: a 44% frequency of MP in ETH users and a significant reduction in MP for those who used HME cassettes. 19 Furthermore, although several randomized controlled trials demonstrate the efficacy of HME cassette use in total laryngectomees, 14,20,21 PS/QI outcomes are likely far more pragmatic. This study's PS/QI design contributes otherwise unavailable effectiveness data surrounding in-hospital HME use.…”

A feasibility and efficacy trial of a hand-held humidification device in patients undergoing radiotherapy for head and neck cancer

“…One retrospective [10] and three prospective studies [11][12][13] have found xerostomia-and mucositis-related benefits in HN RT patients who utilized warm-mist humidification, and studies of inpatient warm-mist humidification have shown decreases in airway inflammation [14], mucus plugging [15], and mucus clearance [16]. However, the humidifiers in these studies are large specialized medical devices that are not easily translatable to an outpatient clinical setting.…”

Cost‐effectiveness analysis of using the heat and moisture exchangers compared with alternative stoma covers in laryngectomy rehabilitation:USperspective

“…12,13 In practice, the HME has shown to contribute to an improvement in pulmonary functioning of patients by decreasing mucus accumulation, frequent daily coughing, irritation of the respiratory tract, and infection of the airways (especially in the cold winter months). 1,2,5,9,[14][15][16] In one study, an improvement in breathing was reported by 88% of laryngectomy patients. 11 A randomized controlled study (RCT) by Mérol et al showed fewer pulmonary complaints, significantly fewer sleeping disturbances, and a higher level of satisfaction among patients using the HME.…”

“…3 Results of previous studies showed that healthcare costs related to HME use were lower compared with external air humidification in the postoperative setting. 10,16,19 An earlier costeffectiveness analysis concluded the use of the HME to be cost-effective in Poland. In this analysis, the occurrence of pulmonary events was estimated based on a survey conducted by physicians, and QoL was sourced from a study using a time-series design.…”