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Heat and moisture exchangers (HME) are used after laryngectomy to help reduce breathing restrictions and compensate nasal functions.
During a total laryngectomy, the entire voicebox (larynx) is removed, which leads to a permanent disconnection of the upper and lower airways and a permanent tracheostoma (a breathing hole in the neck). [1] Prior to the operation, breathing primarily occurs through the nasal airways. In the upper airways, the inhaled air is warmed up or cooled down, to prepare the optimal temperature before the air reaches the lungs. After a total laryngectomy, the upper airways are bypassed and breathing in and out occurs through the tracheostoma in the neck which means that the inhaled air flows directly into the lungs. These anatomical changes lead, among others, to changes in voice production, breathing, and olfaction. The nasal functions of regulating the temperature, humidifying, and filtering of the inhaled air are lost. The lack of these functions impairs the lower airways and the activity of the cilia, which leads to pulmonary problems such as tracheobronchial mucus, excessive sputum production, crusting, which can also cause fatigue and shortness of breath. To at least partially reduce these restrictions and compensate the nasal functions, an HME cassette can be attached over the tracheostoma to provide a means for conditioning, humidifying and to a certain extent filtering the inhaled air.
With the regular use of an HME cassette over a couple of weeks, the pulmonary functions can be significantly improved in the majority of patients regarding reduced sputum production, reduced forced expectoration in order to clear the airways, and thereby reduced stoma cleaning.[ unreliable medical source? ] [2] This is due to improved ventilation and blood oxygenation values, which leads to a better ciliary activity and thus more efficient coughing for mucus clearance from the trachea. Studies show that with regular and enduring use of an HME cassette, pulmonary complaints decrease, regardless of country and climate.[ unreliable medical source? ] [3] [4] These improvements can affect voice pitch, loudness and intelligibility,[ citation needed ] and on sleeping disorders and fatigue, which is often related to pulmonary problems.[ citation needed ]
HME devices can be attached to the tracheostoma in two different ways: peristomally, by use of a base plate, to which the HME can be attached, and intraluminally, by putting the HME into a laryngectomy tube or a stoma button. Adhesive baseplates come in different shapes and properties to meet the users’ differences in anatomy and skin types.
Peristomally through an adhesive on the neck surrounding the stoma There is a variety of adhesive baseplates, that can be used to attach the HME and products that are recommended for proper application and removal of the adhesive complement the portfolio.
Intraluminally through a device that is inserted into the tracheostoma Some laryngectomized patients require a laryngectomy tube to maintain stoma patency, especially in the early postsurgical days and during postoperative radiotherapy. [5] A stoma button is primarily used in stomas that are shrinking.[ citation needed ] This is the preferred solution for many users, but there has to be a tight lip that holds the button in place.
Most patients use one adhesive per day and 1-2 HME cassettes per day.[ citation needed ]
An individual combination of voice prosthesis, HME, and attachment[ clarification needed ] is important for good speech and pulmonary rehabilitation.
Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung. Symptoms typically include a chronic cough with mucus production. Other symptoms include shortness of breath, coughing up blood, and chest pain. Wheezing and nail clubbing may also occur. Those with the disease often get frequent lung infections.
The Buteyko method or Buteyko Breathing Technique is a form of complementary or alternative physical therapy that proposes the use of breathing exercises primarily as a treatment for asthma and other respiratory conditions.
Positive airway pressure (PAP) is a mode of respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, in newborn infants (neonates), and for the prevention and treatment of atelectasis in patients with difficulty taking deep breaths. In these patients, PAP ventilation can prevent the need for tracheal intubation, or allow earlier extubation. Sometimes patients with neuromuscular diseases use this variety of ventilation as well. CPAP is an acronym for "continuous positive airway pressure", which was developed by Dr. George Gregory and colleagues in the neonatal intensive care unit at the University of California, San Francisco. A variation of the PAP system was developed by Professor Colin Sullivan at Royal Prince Alfred Hospital in Sydney, Australia, in 1981.
In anatomy, a nasal concha, plural conchae, also called a nasal turbinate or turbinal, is a long, narrow, curled shelf of bone that protrudes into the breathing passage of the nose in humans and various animals. The conchae are shaped like an elongated seashell, which gave them their name. A concha is any of the scrolled spongy bones of the nasal passages in vertebrates.
Laryngectomy is the removal of the larynx and separation of the airway from the mouth, nose and esophagus. In a total laryngectomy, the entire larynx is removed. In a partial laryngectomy, only a portion of the larynx is removed. Following the procedure, the person breathes through an opening in the neck known as a stoma. This procedure is usually performed by an ENT surgeon in cases of laryngeal cancer. Many cases of laryngeal cancer are treated with more conservative methods. A laryngectomy is performed when these treatments fail to conserve the larynx or when the cancer has progressed such that normal functioning would be prevented. Laryngectomies are also performed on individuals with other types of head and neck cancer. Post-laryngectomy rehabilitation includes voice restoration, oral feeding and more recently, smell and taste rehabilitation. An individual's quality of life can be affected post-surgery.
Nasal congestion is the blockage of nasal breathing usually due to membranes lining the nose becoming swollen from inflamed blood vessels.
Cardiac asthma is the medical condition of intermittent wheezing, coughing, and shortness of breath that is associated with underlying congestive heart failure (CHF). Symptoms of cardiac asthma are related to the heart's inability to effectively and efficiently pump blood in a CHF patient. This can lead to accumulation of fluid in and around the lungs, disrupting the lung's ability to oxygenate blood.
A sputum culture is a test to detect and identify bacteria or fungi that infect the lungs or breathing passages. Sputum is a thick fluid produced in the lungs and in the adjacent airways. Normally, fresh morning sample is preferred for the bacteriological examination of sputum. A sample of sputum is collected in a sterile, wide-mouthed, dry, leak-proof and break-resistant plastic-container and sent to the laboratory for testing. Sampling may be performed by sputum being expectorated, induced, or taken via an endotracheal tube with a protected specimen brush in an intensive care setting. For selected organisms such as Cytomegalovirus or "Pneumocystis jiroveci" in specific clinical settings a bronchoalveolar lavage might be taken by an experienced pneumologist. If no bacteria or fungi grow, the culture is negative. If organisms that can cause the infection grow, the culture is positive. The type of bacterium or fungus is identified by microscopy, colony morphology and biochemical tests of bacterial growth.
Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The application of positive pressure may be intended to prevent upper airway collapse, as occurs in obstructive sleep apnea, or to reduce the work of breathing in conditions such as acute decompensated heart failure. CPAP therapy is highly effective for managing obstructive sleep apnea. Compliance and acceptance of use of CPAP therapy can be a limiting factor, with 8% of people stopping use after the first night and 50% within the first year.
Obstructive lung disease is a category of respiratory disease characterized by airway obstruction. Many obstructive diseases of the lung result from narrowing (obstruction) of the smaller bronchi and larger bronchioles, often because of excessive contraction of the smooth muscle itself. It is generally characterized by inflamed and easily collapsible airways, obstruction to airflow, problems exhaling, and frequent medical clinic visits and hospitalizations. Types of obstructive lung disease include; asthma, bronchiectasis, bronchitis and chronic obstructive pulmonary disease (COPD). Although COPD shares similar characteristics with all other obstructive lung diseases, such as the signs of coughing and wheezing, they are distinct conditions in terms of disease onset, frequency of symptoms, and reversibility of airway obstruction. Cystic fibrosis is also sometimes included in obstructive pulmonary disease.
Respiratory gas humidification is a method of artificially conditioning respiratory gas for the patient during therapy, and involves humidification, warming, and occasionally filtration of the gas being delivered. If these three measures are not performed to compensate for the natural conditioning of air by the respiratory system, lung infections and lung tissue damage may occur. This is particularly problematic in high gas-flow therapies such as [mechanical ventilation], in patient populations with highly sensitive respiratory tracts, or among those requiring ventilation for longer periods of time. The two methods currently available for this purpose are active or passive respiratory gas humidification.
Vocal cord dysfunction (VCD) is a pathology affecting the vocal folds characterized by full or partial vocal fold closure causing difficulty and distress during respiration, especially during inhalation.
Breathing is the process of moving air into and from the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxygen.
Insufflation is the act of blowing something into a body cavity. Insufflation has many medical uses, most notably as a route of administration for various drugs.
An acute exacerbation of chronic obstructive pulmonary disease, or acute exacerbations of chronic bronchitis (AECB), is a sudden worsening of chronic obstructive pulmonary disease (COPD) symptoms including shortness of breath, quantity and color of phlegm that typically lasts for several days.
Obligate nasal breathing describes a physiological necessity to breathe through the nose as opposed to breathing through the mouth.
Heated humidified high-flow (HHHF) therapy, often also high flow nasal cannula(e) (HFNC) or high flow nasal oxygen (HFNO), is a type of respiratory support method that delivers a high flow of medical gas to a patient through an interface intended to create a wash-out of the upper airway. The applied gas is heated to best match human body temperature (37 °C) and humidified targeting ideal body saturation vapor pressure. It is used in acute and chronic breathing problems, and is a suitable choice for treatment of patients with severe or critical COVID-19.
A voice prosthesis is an artificial device, usually made of silicone that is used in conjunction with voice therapy to help laryngectomized patients to speak. During a total laryngectomy, the entire voice box (larynx) is removed and the windpipe (trachea) and food pipe (esophagus) are separated from each other. During this operation an opening between the food pipe and the windpipe can be created. This opening can also be created at a later time. This opening is called a tracheo-esophageal puncture. The voice prosthesis is placed in this opening. Then, it becomes possible to speak by occluding the stoma and blowing the air from the lungs through the inside of the voice prosthesis and through the throat, creating a voice sound, which is called tracheo-esophageal speech. The back end of the prosthesis sits at the food pipe. To avoid food, drinks, or saliva from coming through the prosthesis and into the lungs, the prosthesis has a small flap at the back. There are two ways of inserting the voice prosthesis: through the mouth and throat with the help of a guide wire, or directly through the tracheostoma (anterograde) manner. Nowadays, most voice prosthesis are placed anterograde, through the stoma.
Heat and moisture exchangers (HME) are devices used in mechanically ventilated patients intended to help prevent complications due to "drying of the respiratory mucosa, such as mucus plugging and endotracheal tube (ETT) occlusion." HMEs are one type of commercial humidification system, which also include non-heated-wire humidifiers and heated-wire humidifiers.
Work of breathing (WOB) is the energy expended to inhale and exhale a breathing gas. It is usually expressed as work per unit volume, for example, joules/litre, or as a work rate (power), such as joules/min or equivalent units, as it is not particularly useful without a reference to volume or time. It can be calculated in terms of the pulmonary pressure multiplied by the change in pulmonary volume, or in terms of the oxygen consumption attributable to breathing.