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

Abstract

Objective: This study aimed to evaluate the impact of two tracheostomy heat and moisture exchangers (HMEs), namely the Shikani Oxygen HME™ (S-O2HME, ball type, turbulent airflow) and Mallinckrodt Tracheolife II DAR HME (M-O2HME; flapper type, linear airflow) on tracheobronchial mucosal health, oxygenation, humidification, and patient preference. Methods: A randomized cross-over study was conducted with HME-naïve long-term tracheostomy subjects at two academic medical centers. Bronchoscopy assessments of mucosal health were performed at baseline and day 5 of HME application, along with oxygen saturation (SpO2) and breathed air humidity at four oxygen flow rates (1, 2, 3, and 5 lpm). Patient preference was assessed on study conclusion. Results: Both HMEs were associated with improved mucosal inflammation and decreased mucus production (p < 0.0002), with greater improvements in the S-O2HME group (p < 0.007). Both HMEs improved humidity concentration at each oxygen flow rate (p < 0.0001), without significant differences between groups. SpO2 was greater for the S-O2HME versus the M-O2HME across all measured oxygen flow rates (p = 0.003). At low oxygen flow rates (1 or 2 lpm), the SpO2 in the S-O2HME group was similar to that of the M-O2HME at higher oxygen flow rates (3 or 5 lpm; p = 0.6). Ninety percent of subjects preferred the S-O2HME. Conclusion: Tracheostomy HME uses correlated with improved indicators of tracheobronchial mucosal health, humidity, and oxygenation. The S-O2HME outperformed the M-O2HME with respect to tracheobronchial inflammation, SpO2, and patient preference. Regular HME use by tracheostomy patients is recommended to optimize pulmonary health. Newer ball-type speaking valve technology additionally allows concomitant HME and speaking valve application. Level of Evidence: 2 Laryngoscope, 133:3422–3428, 2023.