Linear versus Turbulent Airflow Tracheostomy Heat and Moisture Exchangers: A Crossover Study

Area of Science:

• Respiratory Medicine
• Biomedical Engineering

Background:

• Tracheostomy patients often require heat and moisture exchangers (HMEs) to maintain airway health.
• Two types of HMEs, the Shikani Oxygen HME™ (S-O2 HME) with turbulent airflow and the Mallinckrodt Tracheolife II DAR HME (M-O2 HME) with linear airflow, were compared.

Purpose of the Study:

• To evaluate the impact of S-O2 HME and M-O2 HME on tracheobronchial mucosal health, oxygenation, humidification, and patient preference.
• To compare the efficacy of a ball-type HME versus a flapper-type HME.

Main Methods:

• A randomized cross-over study involving HME-naïve long-term tracheostomy patients.
• Bronchoscopy assessed mucosal health; oxygen saturation (SpO2) and humidity were measured at various oxygen flow rates.
• Patient preference was recorded at the study's conclusion.

Main Results:

• Both HMEs improved mucosal inflammation and reduced mucus production, with superior results for the S-O2 HME.
• Both HMEs enhanced humidity levels, but the S-O2 HME demonstrated significantly higher SpO2 across all tested oxygen flow rates.
• Ninety percent of participants expressed a preference for the S-O2 HME.

Conclusions:

• Tracheostomy HME use positively impacts tracheobronchial mucosal health, humidity, and oxygenation.
• The S-O2 HME showed better performance in reducing inflammation, improving SpO2, and enhancing patient preference compared to the M-O2 HME.
• Regular HME use is recommended for tracheostomy patients to optimize pulmonary health, with newer technologies enabling combined HME and speaking valve use.