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The Benefits of Heat and Moisture Exchangers (HME’s)
following a Total Laryngectomy
SEPTEMBER 2015
Prepared by:
Independence Products Ltd on behalf of SpiroTectTM
[email protected]
The Benefits of Heat and Moisture Exchangers (HMEs) following Total
Laryngectomy
Breathing is a physiological function essential for sustained life that occurs largely
unconsciously. During inspiration, air flows through the upper airway into the lungs
where respiration (exchange of gases) occurs. In a non-laryngectomized individual,
the inspired air is conditioned (warmed, humidified and cleaned) as it passes through
the upper respiratory tract.
The conditioning that occurs in the upper airways is lost when an individual
undergoes a total laryngectomy. Breathing occurs through the tracheostoma and
this has significant consequences for the respiratory physiology of laryngectomized
individuals.
The relationship between the heat and moisture content of inspired air and
pulmonary function is well established, and there is a large body of literature
documenting the adverse effects of inadequate humidification on the respiratory
tract. In a laryngectomized individual the conditioning of the inspired air during its
passage through the airways is precluded, and results in chronic pulmonary
complaints such as frequent involuntary coughing, increased sputum production,
crusting, forced expectoration and dyspnoea1,2.
Clinical research has clearly demonstrated that the pulmonary function of
laryngectomized individuals is significantly compromised by the division of the upper
and lower airways. Studies suggest that these pulmonary complaints develop and
gradually increase during the six to twelve months post-laryngectomy and then tend
to stabilise3. Seasonal variations in symptoms have also been observed, with an
increase in pulmonary complaints during the winter months4.
The loss of the filtration function of the upper respiratory tract results in an increased
susceptibility to lower respiratory tract infection, as airborne particulates which would
normally be filtered by the upper airways enter the respiratory system via the
tracheostoma. Mucociliary clearance is impeded by a lack of sufficient heat and
moisture in the lower respiratory tract5.
These pulmonary complaints negatively impact the quality of life of the
laryngectomized individual; psychological distress, increased fatigue, sleeping
problems and social disruption have all been cited as psychosocial consequences of
a total laryngectomy1. It is of particular note that in a study into the negative side
effects of total laryngectomy, laryngectomized individuals indicated that the creation
1
Hilgers F J, Ackerstaff A H, Aaronson N K, Schouwenburg P F, van Zandwijk N. Physical and psychosocial
consequences of total laryngectomy. Clin Otolaryngol Allied Sci. 1990 Oct;15(5):421-425.
2
Togawa K, Konno A, Hoshino T. A physiologic study on respiratory handicap of the laryngectomized. Arch
Otorhinolaryngol. 1980; 229(1):69-79.
3
Todisco T, Maurizi M, Paludetti G, Dottorini M, Merante F. Laryngeal cancer: long-term follow-up of
respiratory functions after laryngectomy. Respiration. 1984;45(3):303-315.
4
Natvig K. Influence of different climates on the peak expiratory flow in laryngectomees. J Laryngol Otol.
1984;98(1):53-58.
5
Williams R, Rankin N, Smith T, Galler D, Seakins P. Relationship between the humidity and temperature of
inspired gas and the function of the airway mucosa. Crit Care Med. 1996;24(11):1920-9.
of a permanent tracheostoma and the associated pulmonary complaints ranked
higher in significance than loss of voice. Healthcare professionals who undertook
the same survey believed that loss of voice was the main concern6.
Heat and Moisture Exchangers (HMEs) were developed to address the loss of
pulmonary function experienced by laryngectomized individuals. It is now well
established in the literature that HMEs play an important role in pulmonary
rehabilitation following total laryngectomy7. Consistent daily use of an HME has
been shown in studies to significantly reduce the severity of post-laryngectomy
pulmonary disorders8,9,10.
How HMEs work
Heat and moisture exchangers designed to address the loss of pulmonary function
following a total laryngectomy have been in clinical use for over 30 years. It has
been noted that these medical devices are currently the only effective, nonpharmaceutical treatment for the pulmonary symptoms experienced by
laryngectomized individuals11.
The upper airway moistens, warms and filters inspired air. Mucosal functions are
optimised when inspired gases arrive at the carina at a core temperature of 37 oC
and are fully saturated with moisture (100 relative humidity (RH) = 44mg/L)5. The
natural humidification process which occurs in the upper airway is bypassed in
laryngectomized individuals. Artificial airway humidification is therefore required to
optimise the function of the mucociliary escalator and enable mucosal clearance.
The HME is designed to sit above the tracheostoma and provides a passive
humidification system that captures warm and humidified air as it is exhaled from the
body. Inspired air, which is cool and dry, is then warmed and moistened as it passes
through the filter into the trachea.
HMEs are composed of paper, foam or other material and may be impregnated with
hygroscopic salts such as Calcium Chloride (CaCl2), Aluminium Chloride (AlCl2),
Magnesium Chloride (MgCl2) or Lithium Chloride (LiCl) to increase moisture
6
Mohide E A, Archibald S D, Tew M, Young J E, Haines T. Postlaryngectomy quality-of-life dimensions
identified by patients and health care professionals. Am J Surg. 1992 Dec;164(6):619-22.
7
Zuur J K, Muller S H, de Jongh F H, van Zandwijk N, Hilgers F J. The physiological rationale of heat and
moisture exchangers in post-laryngectomy pulmonary rehabilitation: a review. Eur Arch Otorhinolaryngol.
2006 Jan;263(1):1-8.
8
Hilgers F J, Aaronson N K, Ackerstaff A H, Schouwenburg P F, van Zandwikj N. The influence of a heat and
moisture exchanger (HME) on the respiratory symptoms after total laryngectomy. Clin Otolaryngol Allied Sci.
1991 Apr;16(2):152-6.
9
Ackerstaff A H, Hilgers F J, Aaronson N K, De Boer M F, Meeuwis C A, Knegt P P, Spoelstra H A, Van Zandwijk
N, Balm A J. Heat and moisture exchangers as a treatment option in the post-operative rehabilitation of
laryngectomized patients. Clin Otolaryngol Allied Sci. 1995 Dec;20(6):504-9.
10
Ackerstaff A H, Hilgers F J, Aaronson N K, Balm A J, Van Zandwijk N. Improvements in respiratory and
psychosocial functioning following total laryngectomy by the use of a heat and moisture exchanger. Ann Otol
Rhinol Laryngol. 1993 Nov;102(11):878-83.
11
Hilgers F J, van den Boer C, van den Brekel M W, Muller S. Chapter 13. Pulmonary Function and
Rehabilitation. In Ward E C, van As-Brooks C J eds. Head and Neck Cancer: Treatment, Rehabilitation and
Outcomes. San Diego: Plural Publishing; 2007;401-420.
2
retention12. Antibactericidal solutions such as chlorhexidine may also be
impregnated into the device to inhibit bacterial colonization13. Some HMEs also
contain an electrostatic filter material which further inhibits the ingress of particulates
into the trachea.
Alongside the heat and moisture exchange function, HMEs also provide airway
resistance and particulate filtering and are designed to be used daily to maximise
post-laryngectomy pulmonary function.
Heat and Moisture Exchange
Heat and moisture exchange is one of the most important functions of the respiratory
system. During normal breathing, the airways function as a heat and moisture
exchanger.
Inspired air is conditioned by the upper airways in a non-laryngectomized individual
and reaches a temperature of up to 32oC and relative humidity (RH) of up to 99% at
the level of the trachea14. Air inhaled via a tracheostoma reaches a temperature of
27-28oC and relative humidity (RH) of only 50% at the level of the trachea
significantly decreasing mucociliary clearance15.
The effect of moisture loss during expiration on a laryngectomized individual is
significant, with daily moisture loss of approximately 500ml. During normal nasal
breathing approximately 250ml of water is lost from the lungs each day. Daily use of
an HME facilitates the conservation of moisture within the respiratory system, and
can reduce moisture loss due to tracheostoma breathing to approximately 250-300ml
per day16.
It has been recognized that normative data may not be fully representative for
laryngectomized individuals, who generally are older and often have been smokers
and/or were treated with radiotherapy11. Atrophy of the nasal mucosa may lead to
lower intra-nasal temperature and humidity values in the aging population17.
Studies have confirmed that use of an HME increases both intratracheal temperature
and humidity values18. A recent review noted that in laryngectomized individuals,
12
Thomachot L, Viviand X, Arnaud S, Boisson C, Martin C D. Comparing two heat and moisture exchangers, one
hydrophobic and one hygroscopic, on humidifying efficacy and the rate of nosocomial pneumonia. Chest. 1998
Nov;114(5):1383-9.
13
Grolman W , Blom E D, Branson R D, Schouwenburg P F, Hamaker R C. An efficiency comparison of four heat
and moisture exchangers used in the laryngectomized patient. Laryngoscope. 1997 Jun;107(6):814-20.
14
Ingelstedt S. Studies on the conditioning of air in the respiratory tract. Acta Otolaryngol Suppl. 1956;131:1–
80.
15
Mercke U, Toremalm N G. Air humidity and mucociliary activity. Ann Otol Rhinol Laryngol. 1976 JanFeb;85(1 Pt 1):32–7.
16
Toremalm N G. Heat and moisture exchange for post-tracheostomy care. Acta Otolaryngol. 1960;52:1-12.
17
Ho J C, Chan K N, Hu W H, Lm W K, Zheng L, Tipoe G L et al. The effect of aging on nasal mucociliary
clearance, beat frequency, and ultrastructure of respiratory cilia. Am J Respir Crit Care Med. 2001 Mar;
163(4):983-8.
18
Keck T, Dürr J, Leiacker R, Rettinger G, Rozsasi A. Tracheal climate in laryngectomees after use of a heat and
moisture exchanger. Laryngoscope. 2005 Mar;115(3):534-7.
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typically air of 22°C/40% RH (8 mg/L, 8 g/kg) is conditioned to 27–28°C/50% RH (13
mg/L, 14 g/kg) at the level of the upper trachea without an HME, and to
29-30°C/70% RH (21 mg/L, 22 g/kg) with an HME7. Without artificial airway
humidification, the air entering the lower respiratory tract will lack sufficient heat and
moisture, the function of the mucociliary escalator will be compromised, and damage
may occur to the respiratory cilia and epithelium leading to an increase in pulmonary
complaints.
The validation of the water exchange performance of HMEs has been the subject of
a number of recent studies. Performance is determined by assessment of the weight
change of the HME between the end of inhalation and end of exhalation 19. It has
been found that wet core weight is a predictor of HME water exchange performance.
HMEs containing a hygroscopic salt, which increases the weight of the core material,
demonstrate enhanced HME performance20.
Whilst it is recognized that an HME cannot completely restore the physiological
functions of the upper respiratory tract, daily use of an HME ensures that a better
quality of air is delivered to the lower airways which has a positive effect on tracheal
mucosa21.
To ensure optimal performance the HME should be changed daily. More frequent
changes may be required if the HME becomes obstructed with mucus22. Studies
have confirmed that from a functional point of view the recommendation for daily
device replacement is justified23.
The positive impact of HMEs on post-laryngectomy respiratory function is now well
established24,25,26,27. Regular use of an HME, which increases intra-tracheal
humidity, has been shown to lead to significant improvement of both pulmonary
19
van den Boer C, Muller S H, Vincent A D, Züchner K, van den Brekel M W, Hilgers F J. A novel, simplified ex
vivo method for measuring water exchange performance of heat and moisture exchangers for tracheostomy
application. Respir Care. 2013 Sep;58(9):1449-58.
20
van den Boer C, Muller S H, Vincent A D, van den Brekel M W, Hilgers F J. Ex vivo assessment and validation
of water exchange performance of 23 heat and moisture exchangers for laryngectomized patients. Respir Care.
2014 Aug;59(8):1161-71.
21
Rosso M, Prgomet D, Marjanović K, Pušeljić S, Kraljik N. Pathohistological changes of tracheal epithelium in
laryngectomized patients. Eur Arch Otorhinolaryngol. 2014 Nov 16. [Epub ahead of print].
22
Ackerstaff A H, Hilgers F J, Balm A J, Tan IB. Long-term compliance of laryngectomized patients with a
specialised pulmonary rehabilitation device: Provox Stomafilter. Laryngoscope. 1998 Feb; 108(2):257-260.
23
van den Boer C, Vas Nunes J H, Muller S H, van der Noort V, van den Brekel M W, Hilgers F J. Water Uptake
Performance of Hygroscopic Heat and Moisture Exchangers after 24-Hour Tracheostoma Application.
Otolaryngol Head Neck Surg. 2014 Mar 28;150(6):999-1004. [Epub ahead of print].
24
Ackerstaff A H, Fuller D, Irvin M, Maccracken E, Gaziano J, Stachowiak L. Multicenter study assessing effects
of heat and moisture exchanger use on respiratory symptoms and voice quality in laryngectomized individuals.
Otolaryngol Head Neck Surg. 2003 Dec; 129(6):705-712.
25
Bień S, Okla S, van As-Brooks C J, Ackerstaff A H. The effect of a Heat and Moisture Exchanger (Provox HME)
on pulmonary protection after total laryngectomy: a randomized controlled study. Eur Arch Otorhinolaryngol.
2010 Mar; 267(3):429-35.
26
Dassonville O, Mérol J C, Bozec A et al. Randomised, multi-centre study of the usefulness of the heat and
moisture exchanger (Provox HME(R)) in laryngectomized patients. Eur Arch Otorhinolaryngol. 2011 Nov;
268(11):1647-54.
27
Lorenz K J, Maier H. [Pulmonary rehabilitation after total laryngectomy using a heat and moisture exchanger
(HME)]. Laryngorhinootologie. 2009 Aug; 88(8):513-22.
4
complaints and the associated psychosocial problems of laryngectomized
individuals. This in turn has a significant impact on quality of life postlaryngectomy8,10. It has also been recognized that regular use of an HME appears to
have a positive influence on voice quality11.
A recent study into the long-term use of heat and moisture exchangers concluded
that compliant HME users tend to make less use of external humidifiers and
vaporisers, have better pulmonary status and lower health-care costs28.
Airway Resistance
Airway Resistance is a concept in respiratory physiology that describes the
resistance of the respiratory tract to airflow during inspiration and expiration. In nonlaryngectomized individuals 75% of total airway resistance takes place in the upper
respiratory tract.
In laryngectomized individuals, where air bypasses the upper airways and enters the
body through the tracheostoma, airway resistance is compromised.
Whilst it is recognized that an HME cannot completely replicate the airway resistance
of the upper respiratory tract, daily use of an HME has been shown to help restore
lost airway resistance29 and it has been argued may also play a role in improving
arterial oxygenation although this influence has been challenged30,31.
HMEs are available which offer differing levels of resistance to suit individual
requirements. HME devices which deliver normal airway resistance are most suited
for everyday use. Low-resistance devices are suitable for periods of increased
activity32. As HMEs have been shown to have a positive impact on postlaryngectomy pulmonary function it is essential that compliance is optimised, and the
level of breathing resistance provided by the device should be as comfortable as
possible.
It has been noted that the clinical advantage of high-breathing resistance HME
devices, if any, is expected to be limited. Patients may perceive breathing through a
high-resistance HME to be uncomfortable, particularly during exercise as the HME
resistance is fixed and thus does not adapt to different levels of physical exertion 11.
28
Brook I, Bogaardt H, van As-Brooks C. Long-term use of heat and moisture exchangers among
laryngectomees: medical, social, and psychological patterns. Ann Otol Rhinol Laryngol. 2013 Jun;122(6):35863.
29
Verkerke G J, Geertsema A A, Schutte H K. Airflow resistance of heat and moisture exchange filters with and
without a tracheostoma valve. Ann Otol Rhinol Laryngol. 2002 Apr;111(4):333-7.
30
McRae D, Young P, Hamilton J, Jones A. Raising airway resistance in laryngectomees increases tissue oxygen
saturation. Clin Otolaryngol Allied Sci. 1996 Aug: 21(4);366-8.
31
Zuur J K, Muller S H, Sinaasappel M, Hart G A, van Z N, Hilgers F J. Influence of heat and moisture exchanger
respiratory load on transcutaneous oxygenation in laryngectomized individuals: a randomised crossover study.
Head Neck 2007 Dec; 29 (12):1102-10.
32
Jones A S, Young P E, Hanafi Z B, Makura Z G, Fenton J E, Hughes J P. 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. Head
Neck. 2003 May;25(5):361-7.
5
It has been shown that greater compliance is achieved by the use of a lower
breathing-resistance HME30.
Reducing the risk of infection
An adult inspires up to an estimated 10,000 litres of air per day and the nasal cavity
forms the first line of defence against airborne environmental particles such as pollen
and dust as well as microorganisms such as bacteria, fungi and viruses.
In non-laryngectomized individuals the inhaled air is filtered as it passes through the
upper airways. Bacteria and viruses have to run the gauntlet of the respiratory
epithelium of the upper airways in order to enter the trachea.
Laryngectomized individuals are statistically more prone to chest infections, including
pneumonia. Pneumonia has been found to be the most frequent medical
complication after total laryngectomy33.
An increase in prevalence of lower respiratory tract infections (LRTIs) in patients in
British hospitals has been demonstrated in patients with a tracheostomy34.
Prevalence was found to be greater in smokers, in males, and in those aged over 75
years. This is of particular relevance as 70% of those undergoing a total
laryngectomy procedure in England and Wales between 2003-04 and 2013-14 were
aged 60 and above. 85% of those undergoing total laryngectomy were male35. A
recent study has shown that the incidence of LRTIs and community acquired
pneumonia increases markedly with age which has significant implications for the
laryngectomized population36.
It is recognized that effective mucus clearance is a critical innate airway defence
mechanism37. It is thus to be anticipated that laryngectomized individuals, whose
upper airway function has been lost, will be more susceptible to LRTIs. Unless the
airway is kept sufficiently humidified, mucus will become thicker and harder to expel,
providing an ideal breeding climate for bacteria and viruses. Regular daily use of an
HME will encourage mucociliary clearance and thus help reduce the risk of airway
infection.
It has been shown that long-term HME compliance significantly reduces pulmonary
complaints and pulmonary infection rates. In a randomized control trial comparing
33
Herranz J, Sarandeses A, Fernández M F, Barro C V, Vidal J M, Gavilán J. Complications after total
laryngectomy in nonradiated laryngeal and hypopharyngeal carcinomas. Otolaryngol Head Neck Surg. 2000
Jun;122(6):892-8.
34
Kelsey M C, Mitchell C A, Griffin M, Spencer R C, Emmerson A M. Prevalence of lower respiratory tract
infections in hospitalized patients in the United Kingdom and Eire – results from the Second National
Prevalence Survey. J Hosp Infect. 2000 Sep;46(1):12-22.
35
Hospital Episode Statistics (HES), Admitted Patient Care, England 2003-04 to 2013-14 - www.hscic.gov.uk,
accessed 15.07.15; Public Health Wales Observatory, Patient Episode Database for Wales (PEDW) 2003-04 to
2013-14 - www.infoandstats.wales.nhs.uk, accessed 15.07.15.
36
Millett E R, Quint J K, Smeeth L, Daniel R M, Thomas S L. Incidence of Community-Acquired Lower
Respiratory Tract Infections and Pneumonia among Older Adults in the United Kingdom: A Population-Based
Study. PLoS One. 2013; 8(9): e75131.
37
Randell S H, Boucher R C. Effective mucus clearance is essential for respiratory health. Am J Respir Cell Mol
Biol. 2006;35(1):20-28.
6
pulmonary complaints between HME users and a placebo group, subjective lower
airway parameters, including cough, number of chest infections, mucus production,
and shortness of breath at rest, were significantly improved in the active group
compared with the placebo group4.
The HME device itself provides a moist environment that is potentially an ideal
breeding ground for pathogens. A recent study has concluded however that the use
of HMEs does not endanger tracheostomy patients in terms of additional exposure to
pathogenic microorganisms38.
Indeed use of an HME is associated with a decrease in incidence of
tracheobronchitis and/or pneumonia in laryngectomized individuals. A recent survey
found that a lower incidence of severe tracheobronchitis and/or pneumonia was
found in HME users compared to non-HME users39.
LRTIs impact severely on the quality of life of laryngectomized individuals. It is
unsurprising that “fear” of pneumonia has been found to have a severe impact on
quality of life post total laryngectomy40.
Conferring further clinical benefits, HMEs are now available with antibacterial
properties that help prevent bacteria and viruses entering the airway. A filtration
layer is added to the traditional HME to provide antimicrobial filtering. Whilst further
studies are required to validate the antibacterial function of these devices within the
laryngectomy population, HMEs with filters have long been used in ventilated
patients. In a randomized study to compare the degree of bacterial circuit
colonization in patients undergoing mechanical ventilation, circuits with a bacterialviral filtering HME were found to be less readily colonized by bacteria 41. There is
evidence from a comparative study suggesting that HMEs with filters significantly
decrease the rate of ventilator-associated pneumonia in comparison with heated
humidifiers42.
As noted above to ensure optimal performance and maximise the protective effect
the HME should be changed daily.
Whilst there is debate in the literature as to whether the reduction in airway infection
should be attributed more to pathogen filtration or the improved humidity values
which may stimulate cilia activity7, studies have convincingly shown that a decrease
in the frequency of airway infections may be attributable to the consistent use of an
HME32,39.
38
Kramp B, Donat M, Dommerich S, Pau H W, Podbielski A. Prospective controlled study of microbial
colonization of the trachea in tracheotomised and laryngectomized patients with HME (heat and moisture
exchanger). Acta Otolaryngol. 2009;129(10):1136-1144.
39
van den Boer C, van Harten M C, Hilgers F J, van den Brekel M W, Retèl V P. Incidence of severe
tracheobronchitis and pneumonia in laryngectomized patients: a retrospective clinical study and a Europeanwide survey among head and neck surgeons. Eur Arch Otorhinolaryngol. 2014 Dec;271(12):3297-303.
40
Pernambuco L de A, Oliveira J H P de, Régis R M F L, et al. Quality of life and deglutition after total
laryngectomy. Int Arch Otorhinolaryngol. 2012;16(4):460-465.
41
Boots R J, Howe S, George N, Harris F M, Faoagali J. Clinical utility of hygroscopic heat and moisture
exchangers in intensive care patients. Crit Care Med. 1997 Oct;25(10):1707-12.
42
Kranabetter R, Leier M, Kammermeier D, Just H M, Heuser D. [The effects of active and passive
humidification on ventilation-associated nosocomial pneumonia]. Anaesthesist. 2004 Jan;53(1):29-35.
7
Reducing the cost of infection
LRTIs including pneumonia represent a significant burden of illness for both the
patient and the NHS43.
Treatment may include antibiotics (oral and intravenous), and involve routine
diagnostics such as X-rays, CT scans and cultures all of which have a significant
cost.
It is estimated that 22-42% of people with community-acquired pneumonia are
admitted to hospital. Based on HES (Hospital Episode Statistics) data,
approximately 175,000 people were admitted to hospital in 2013/14 with communityacquired pneumonia. The mean length of stay was 12.32 days44.
The mortality rate in hospital is between 5% and 14%. Between 1.2% and 10% of
adults admitted to hospital with community-acquired pneumonia are managed in an
intensive care unit, and for these patients the risk of dying is more than 30%.
As noted above, due to underlying health issues and the average age of
laryngectomized individuals, there is an increased likelihood that hospitalisation will
be required in the event of acquiring a respiratory infection.
Reducing emergency hospital admissions for ambulatory care-sensitive conditions
(ACSCs) is listed as a key indicator for transforming care for people with long-term
conditions in The Operating Framework for the NHS in England 2012/13
(Department of Health 2011b). ACSCs are defined as conditions for which hospital
admissions could be avoided by interventions in preventive and primary care. A
2012 Data Briefing from the King’s Fund estimated that influenza and pneumonia
account for the largest proportion of hospital admissions (13 per cent) and
expenditure (£286 million)45.
The NHS Reference Costs for 2013/14 indicate that treatment for respiratory tract
infections with complications and comorbidities can cause a significant financial
burden to the NHS. The cost of treating a single episode of an acute lower
respiratory tract infection can cost the NHS in excess of £7,00046.
HME systems are available on NHS prescription and help protect laryngectomized
individuals from LRTIs from £5.27 per day, at a cost to the NHS per annum of
£1923.55 (based on the daily use of a SpiroTectTM antibacterial HME cassette and
baseplate).
43
NICE Costing statement: Pneumonia – diagnosis and management of community- and hospital acquired
pneumonia in adults: Implementing the NICE guideline on pneumonia (CG191), December 2014.
44
Office for National Statistics (ONS), Admitted Patient Care: England 2013-14, Diagnosis.
45
The King’s Fund Data Briefing (2012. Emergency hospital admissions for ambulatory care-sensitive
conditions: identifying the potential for reduction
46
NHS Reference Costs 2013-14 - Unspecified Acute Lower Respiratory Infection with CC Score 14+; Elective
Stay £8851.05, Non-Elective Stay £7077.07.
8
A recent study in Poland investigated the cost-effectiveness of HMEs versus usual
care and concluded that HMEs were both less costly and more effective than
traditional rehabilitation techniques47.
Conclusion
Pulmonary function is compromised following total laryngectomy. Without
humidification the air entering the lower respiratory tract will lack sufficient heat and
moisture. Use of an HME increases intratracheal temperature and humidity values.
Consistent daily use of an HME aids pulmonary rehabilitation and significantly
reduces the severity of post-laryngectomy pulmonary disorders and associated
psychosocial problems.
Laryngectomized individuals are statistically more prone to lower respiratory tract
infections including pneumonia. Lower respiratory tract infections represent a
significant burden of illness for both the patient and the healthcare system. A
decrease in the frequency of airway infections is associated with consistent use of an
HME and may thus be expected to ease the financial burden on the NHS.
47
Retèl V P, van den Boer C, Steuten L M, Okła S, Hilgers F J, van den Brekel M W. Cost-effectiveness of heat
and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in
Poland. Eur Arch Otorhinolaryngol. 2015 Sep;272(9):2381-8.
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