Expiratory pressures generated by heat moisture exchangers in laryngectomized patients

HMEs (Heat and Moisture Exchangers) are used postoperatively in laryngectomized patients to replace upper airway functions such as heating, humidification, filtration and resistance that are lost by the surgery. The clinical value of HME resistance function is controversial. There are no studies reporting actual measurements of air pressure generated by HMEs during breathing. In this paper we evaluated air pressures generated by HMEs (XtraFlow^Ⓡ, XtraMoist^Ⓡ, LifeGo^Ⓡ, and LifeHome^Ⓡ. Atos Medical, Japan), compared the obtained data with theoretical pressure, and discussed the comparison with the expiratory pressure of pursed lips breathing reported in the past.

Nine patients who had laryngectomy were enrolled in this study. All participants were male, and the mean age was 72.3 ± 6.7. A pressure measurement system using a U-shaped water manometer was created to measure pressures generated by HMEs. Expiratory pressures were measured in all HMEs at rest and in XtraFlow^Ⓡ and LifeGo^Ⓡ during light exercise.

Peak expiratory pressure was 5.67 mmH2O (95 %CI, 3.24 to 8.11) and time averaged expiratory pressure was 3.00 mmH2O (95 %CI, 1.56 to 4.45). These pressures were consistent with theoretical values. The finer HME, the higher pressure. The coarse filters had lower expiratory pressure but did not exceed the pressure from the fine filters even with the added pressure from the treadmill load (3Mets).

Endotracheal pressure was approximately less than 10 mmH2O during expiration in Atos HMEs. The fine filters, such as XtraMoist^Ⓡ and LifeHome^Ⓡ, had greater exhalation pressures than coarse filters such as XtraFlow^Ⓡ and LifeGo^Ⓡ. The pressure drops of HMEs seemed lower than the pressure drops added by pursed lips expiration and HMEs may not be a substitute for pursed lips expiration.