Early post-operative pulmonary hygiene
Another advantage with Provox HME is, that the colloid plaster can be used early post-operatively, even with the stitches still in situ (see figures right). In our department we have adopted the custom to apply the Provox HME colloid plaster (OptiDerm) already at the first post-operative day. Since we always try to create a stable tracheostoma, that does not need a tracheostomy cannula to be kept open, this adhesive can easily be glued to the peristomal skin. This makes external humidification superfluous, and appears to be very cost effective. This custom has several other definitive advantages: the patient has optimal stoma protection as early as possible, the need to use suction to clear the trachea from sputum appears to be diminished, noisy external humidification is avoided, the patient gets used to the HME early (no problem with the airflow resistance of the device, because this is lower than the preoperative upper airway resistance), the stoma has a well cared for appearance for the family and other visitors.
If the patient postoperatively needs a cannula in order to keep the stoma sufficiently open, it is still possible to use an HME immediately by applying a LaryTube cannula, which has a special adapter to hold the HME, as can be seen in the top and middle figure to the right. In this case the HighFlow cassette should be used, because of the airflow resistance of the cannula itself. If there is a need for using a standard tracheostomy tube, the TrachPhone HME can be applied, which also has an adapter for oxygen application, if needed (figure right).
Another advantage of using the Provox HME system immediately postoperatively is found in early voice rehabilitation. In the figures on the previous page an example is given of a patient 12 days postoperatively. Often, patients are somewhat reluctant to start with the speech therapy, because it can be difficult to close the not yet nicely healed ‘rounded’ stoma, and because the skin still might be somewhat sore. By applying the HME, the patient can start with speech therapy and will be able to properly close the stoma digitally in a hygienic way, without undue pressure on the suture lines.