title: A novel, simplified ex vivo method for measuring water exchange performance of heat and moisture exchangers for tracheostomy application.
abstract: BACKGROUND
  Breathing through a tracheostomy results in insufficient warming and humidification of inspired air. This loss of air-conditioning can be partially compensated for with the application of a heat and moisture exchanger (HME) over the tracheostomy. In vitro (International Organization for Standardization [ISO] standard 9360-2:2001) and in vivo measurements of the effects of an HME are complex and technically challenging. The aim of this study was to develop a simple method to measure the ex vivo HME performance comparable with previous in vitro and in vivo results.
  
  
  METHODS
  HMEs were weighed at the end of inspiration and at the end of expiration at different breathing volumes. Four HMEs (Atos Medical, Hörby, Sweden) with known in vivo humidity and in vitro water loss values were tested. The associations between weight change, volume, and absolute humidity were determined using both linear and non-linear mixed effects models.
  
  
  RESULTS
  The rating between the 4 HMEs by weighing correlated with previous intra-tracheal measurements (R(2) = 0.98), and the ISO standard (R(2) = 0.77).
  
  
  CONCLUSIONS
  Assessment of the weight change between end of inhalation and end of exhalation is a valid and simple method of measuring the water exchange performance of an HME.
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Cindy
authors.initials: C
authors.lastname: van den Boer
authors.forename: Sara H
authors.initials: SH
authors.lastname: Muller
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Vincent
authors.forename: Klaus
authors.initials: K
authors.lastname: Züchner
authors.forename: Michiel W M
authors.initials: MW
authors.lastname: van den Brekel
authors.forename: Frans J M
authors.initials: FJ
authors.lastname: Hilgers
mesh_terms: D000328:Adult; D045853:Exhalation; D005260:Female; D006361:Heating; D006801:Humans; D006813:Humidity; D001239:Inhalation; D007825:Laryngectomy; D016014:Linear Models; D008297:Male; D012138:Respiratory Therapy / Q000295:instrumentation*; D013147:Spirometry; D014139:Tracheostomy; D014894:Weights and Measures
keywords: heat and moisture exchanger; humidity; respiration; total laryngectomy; tracheostomy