HME Evidence and Benefits

A systematic review comparing active humidification (Conventional External Humidification Systems) and passive humidification (Heat and Moisture Exchangers) in spontaneously breathing patients with a surgical airway reported HME to be the preferred choice of humidification due to the reduction in pulmonary complaints and better patient compliance.Authors reported, “In the context of critical care, heated humidification is most commonly used despite a lack of consensus about the ideal means of providing humidification”.¹

Additionally, several systematic reviews and meta-analyses have compared and evaluated the impact of HME and Conventional External Humidification Systems CEHS during mechanical ventilation. None of them found the superiority of HMEs or CEHS for outcomes such as ventilator-associated pneumonia, mortality, length of intensive care unit stays, airway occlusion, or duration of mechanical ventilation.^2,3

In the laryngectomy patient population, the use of HMEs has shown short-term effects such as reduced dispersion of droplets, better management of secretions, decreased tracheal dryness and irritation, and improved tracheostoma hygiene. Long-term effects have also been reported. After two weeks of HME use, researchers found reduced mucus production and plugging, shortness of breath, and pulmonary infections. Significant improvements were reported in sleep, fatigue, psychosocial aspects, and quality of life.^4-10

In a study comparing TrachPhone HME and CEHS with spontaneously breathing patients with a tracheostomy, HME was found to be the preferred method of humidification due to reports of improved patient mobility, ease of set up and caregiver education, and lower cost.

Although an HME may not be appropriate in every situation, research indicates that HMEs are an effective method of humidification and should, therefore, be strongly considered when making clinical decisions about humidification approaches.¹¹

References:

¹ Wong CY, Shakir AA, Farboud A, Whittet HB. Active versus passive humidification for self-ventilating tracheostomy and laryngectomy patients: a systematic review of the literature. Clin Otolaryngol. 2016;41(6):646-51.
²Gillies D, Todd DA, Foster JP, Batuwitage BT. Heat and moisture exchangers versus heated humidifiers for mechanically ventilated adults and children. Cochrane Database Syst Rev. 2017;9:CD004711.
³Vargas M, Chiumello D, Sutherasan Y, Ball L, Esquinas AM, Pelosi P, et al. Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) in adult critically ill patients: a systematic review, meta-analysis and meta-regression of randomized controlled trials. Crit Care. 2017;21(1):123.
⁴Jones AS, Young PE, Hanafi ZB, Makura ZG, Fenton JE, Hughes JP. 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;25(5):361-7.
⁵Bien S, Okla S, van As-Brooks CJ, Ackerstaff AH. The effect of a Heat and Moisture Exchanger (Provox HME) on pulmonary protection after total laryngectomy: a randomized controlled study. Eur Arch Otorhinolaryngol. 2010;267(3):429-35.
⁶Dassonville O, Merol JC, Bozec A, Swierkosz F, Santini J, Chais A, et al. Randomised, multi-centre study of the usefulness of the heat and moisture exchanger (Provox HME(R)) in laryngectomised patients. Eur Arch Otorhinolaryngol. 2011;268(11):1647-54.
⁷Merol JC, Charpiot A, Langagne T, Hemar P, Ackerstaff AH, Hilgers FJ. Randomized controlled trial on postoperative pulmonary humidification after total laryngectomy: External humidifier versus heat and moisture exchanger. Laryngoscope. 2012;122(2):275-81.
⁸Parrilla C, Minni A, Bogaardt H, Macri GF, Battista M, Roukos R, et al. Pulmonary Rehabilitation After Total Laryngectomy: A Multicenter Time-Series Clinical Trial Evaluating the Provox XtraHME in HME-Naive Patients. The Annals of otology, rhinology, and laryngology. 2015;124(9):706-13.
⁹Foreman A, De Santis RJ, Sultanov F, Enepekides DJ, Higgins KM. Heat and moisture exchanger use reduces in-hospital complications following total laryngectomy: a case-control study. J Otolaryngol Head Neck Surg. 2016;45(1):40.
¹⁰Ebersole B, Moran K, Gou J, Ridge J, Schiech L, Liu JC, et al. Heat and moisture exchanger cassettes: Results of a quality/safety initiative to reduce postoperative mucus plugging after total laryngectomy. Head Neck. 2020
¹¹Kearney A, Norris K, Bertelsen C, Samad I, Cambridge M, Croft G, et al. Adoption and Utilization of Heat and Moisture Exchangers (HMEs) in the Tracheostomy Patient. Otolaryngol Head Neck Surg. 2023.