Prevention aspects

Also a study was performed to investigate whether the use of an HME could prevent the development or reduce the severity of respiratory symptoms by initiating use of the device as soon as possible following total laryngectomy.7 Comparing the pulmonary complaints in a regular user and a non-regular user group at 3 and 6 months postoperatively, statistically significant group differences over time in the frequency of forced expectoration, and stoma cleaning and marginally significant differences in sputum production were observed. A clear trend could be seen, with regular HME users reporting a decline in respiratory symptoms over time as compared with non-regular HME users who reported an increase in these symptoms. These results show that an early start can prevent the development of respiratory symptoms considerably. From these and other studies, it can be concluded that, at present, the only effective non-pharmaceutical treatment of pulmonary problems in laryngectomized patients is the regular use of an HME.


See also page on Early postoperative hygiene.

Immediate postp HME use

Recent RCT underlining the benefits of immediate postoperative application of an HME in stead of an External Humidifier.

Jean-Claude Mérol, Anne Charpiot, Thibault Langagne, Patrick Hémar, Annemieke H Ackerstaff, Frans JM Hilgers. Randomized controlled trial on postoperative pulmonary humidification after total laryngectomy: External Humidifier versus Heat and Moisture Exchanger. Laryngoscope online November 24, 2011

Abstract:

Objectives/Hypothesis: Assessment of immediate postoperative airway humidification after total laryngectomy (TLE), comparing the use of an external humidifier (EH) with humidification through a heat and moisture exchanger (HME).

Study Design: Randomized controlled trial (RCT).

Methods: Fifty-three patients were randomized into the standard (control) EH (N 1/4 26) or the experimental HME arm (N 1/4 27). Compliance, pulmonary and sleeping problems, patients’ and nursing staff satisfaction, nursing time, and cost-effectiveness were assessed with trial-specific structured questionnaires and tally sheets.

Results: In the EH arm data were available for all patients, whereas in the HME arm data were incomplete for four patients. The 24/7 compliance rate in the EH arm was 12% and in the HME arm 87% (77% if the four nonevaluable patients are considered noncompliant). Compliance and patients’ satisfaction were significantly better, and the number of coughing episodes, mucus expectoration for clearing the trachea, and sleeping disturbances were significantly less in the HME arm (P < .001). This was also the case for nursing time and nursing staff satisfaction and preference.

Conclusions: This RCT clearly shows the benefits of immediate postoperative airway humidification by means of an HME over the use of an EH after TLE. This study therefore underlines that HMEs presently can be considered the better option for early postoperative airway humidification after TLE.