Heat and moisture exchange devices improved sleep, fall risk, mobility, and communication compared with conventional systems for patients with tracheostomy.
“For years, we have been using external humidification machines to manage changes in the respiratory system after tracheostomy,” Ann Kearney, CScD, CCC-SLP, BCS-S, says. “A more efficient and effective way to compensate for the change is with a heat and moisture exchange device (HME). Clinical research demonstrating the effectiveness of these is abundant in the total laryngectomy patient population. However, there has been a lack of awareness, as well as resistance to change, for the tracheostomy patient population.”
For a study published in Otolaryngology—Head & Neck Surgery, Dr. Kearney and colleagues conducted a quality improvement project that assessed the use and efficacy of HMEs in patients with a tracheostomy. The study also assessed the benefits of HMEs compared with conventional external humidification systems (CEHS).
Patients with a CEHS protocol received HME devices upon transfer from the recovery unit to the medical-surgical nursing unit. The single-center study examined efficacy through patient pulmonary status, nursing notes, and questionnaires.
Significant Benefits for Patients & Staff
Among 71 patients with tracheostomy enrolled, two (2.8%) were unable to tolerate the HME because of increased tracheostomy suctioning needs. Dr. Kearney and colleagues reported no complications due to mucus plugging or respiratory distress.
“The number of benefits for the patients and nursing staff identified during this project was significant: better sleep, lower fall risk, increased mobility, and improved communication,” Dr. Kearney says. “There are significant cost savings with switching to a newer, better system, not only in terms of the actual device costs, but also in getting patients discharged sooner because of less training required and access to these traditional humidification machines (Table).”
Dr. Kearney also notes that there were no complications in the switch from CEHS to HME.
The majority of nursing staff surveyed (24/27; 89%) indicated a preference for the HME device compared with the CEHS. Better patient mobility and improvements in the ability to ambulate were the main reasons for this preference. Reduced noise in the patient’s room and the ease with which setup could be completed were also identified as factors for preferring the HME over the CEHS.
“The device has been available for some time, but there was resistance to change, including the changing of set protocols from how one was ‘trained,’” Dr. Kearney says. “It took buy-in from a variety of specialists, not just one group. Having nursing support was key since many times their protocols can be a limiting factor.”
Switch Can Be Made “Immediately”
The researchers noted, in the study results, that feedback from nursing staff indicated “multiple benefits” for patients with tracheostomy in switching from CHES to HME, although the study did not collect responses directly from patients.
“Overall, and not unimportantly, patients and staff reported more effective verbal communication in the early postoperative period, as patients can phonate with an HME sooner than with the previous humidification set‐up,” the study authors wrote.
There was no indication of complications among patients sent home with HMEs.
The findings from this quality improvement project are “a game-changer for the care of patients with tracheostomy,” Dr. Kearney says, noting that the switch from CHES to HME can be implemented immediately for this patient population. She also pointed to directions for future research.
“Randomized controlled trials are needed to look at specific pulmonary function measurements in this population,” Dr. Kearney concludes. “There are many studies looking at benefits in the total laryngectomy population, but not yet in patients with a tracheostomy.”
