TrachPhone – The Multifunctional HME

An HME often favored by patients and clinicians is the TrachPhone HME (Figure 1). This multifunctional HME, designed for spontaneously breathing patients, incorporates a speech valve, oxygen port, and suction port. The HME contains a hygroscopic compound, which has been shown to provide better moisture output to the respiratory system when compared to non-hygroscopic HMEs.¹

Figure 1. TrachPhone HME

TrachPhone offers the following additional features:

• Speech valve: TrachPhone contains a valve with a spring that can easily be depressed with a finger to facilitate speech. After releasing the finger, the valve will open automatically. See Figure 2.

Figure 2. Speech valve

• Suction port: The integrated suction port allows tracheal suctioning without removing the HME. See Figure 3.

Figure 3. Suction port

• Oxygen port: TrachPhone has an O₂ port (4 mm) that allows integrated administration of supplemental oxygen, up to 4 liters. See Figure 4.

Figure 4. Oxygen port

TrachPhone Study Results

In a recent quality improvement project at Stanford University School of Medicine, researchers evaluated the feasibility and effectiveness of using TrachPhone HMEs by patients who underwent a tracheotomy in a hospital setting. They compared this approach to the CEHS. The efficacy of TrachPhone HMEs was assessed by monitoring patients’ tolerance to the HME (assessed by respiratory status and suction needs), reviewing nursing notes, and conducting questionnaires. Seventy-one spontaneously breathing patients with tracheostomy were enrolled in this study and, the following results were reported:

• 97% (69/71) of patients tolerated TrachPhone HME immediately post-op
• 3% of patients (2/71) did not tolerate the HME due to elevated suctioning needs via tracheostomy
• None of the patients developed respiratory distress, air trapping, or mucus plugs.
• 89% of nurses preferred TrachPhone HME over traditional CEHS
• The primary reasons for nursing preference for the TrachPhone HME over CEHS were improved patient mobility, decreased noise in the patient’s room, and ease of set-up. See Figure 5.

Figure 5. HME tolerance and Preference. A) 97% (69/71) of patients tolerated the TrachPhone HME immediately post-op, B) 89% (24/27) nurses preferred the TrachPhone HME over traditional CEHS for inhaled air humidification.

Additional positive results included:

• Patient satisfaction. The authors stated that several patients reported that the HME was more comfortable than CEHS and that the reduction in noise allowed them to sleep better.
• Cost savings. The projected annual cost reduction was $68,000 (based on projected annual 325 tracheostomy procedures, based on 1 HME/day, in the USA). See Figure 6.
• Increased patient communication. Nurses reported that patients who used TrachPhone speech valve function were able to communicate earlier compared to the CEHS. With an increase in effective communication, less anxiety regarding care and improved overall well‐being were reported.
• Less training for patients and caregivers. The authors reported ease of patient and family training when HMEs were substituted for CEHS and stated that patients could often apply the HME independently, which promotes self‐care.
• Decrease in suction requirements. The authors mention that tracheostomy collars are sometimes displaced and misaligned, which prevents optimal and steady humidification. They surmise that because the HME is attached directly to the tracheostomy tube, more consistent heat and humidification are delivered, which may decrease the tenacity of secretions.²

Figure 6. Cost Analysis of CEHS compared to HME use. A) Inpatient setup cost is 53% less for HMEs compared to CEHS, and B) monthly outpatient cost is 67% lower with HMEs compared to CEHS.

Summary

Optimal pulmonary health relies on adequate humidification. In patients with tracheostomy, artificial humidification is essential since the upper airway is bypassed. HMEs offer several advantages over traditional external humidifiers, including improved patient compliance, reduced training requirements for patients and caregivers, reduced pulmonary complaints, and cost savings. Given these advantages, clinicians and healthcare facilities should consider incorporating HMEs into the care plans for patients with tracheostomy to enhance their overall pulmonary health and quality of life.

References:

¹Mebius C. A comparative evaluation of disposable humidifiers. Acta Anaesthesiol Scand. 1983;27(5):403-9.
²Kearney 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.