Patients and Caregivers
Healthcare Professionals

Getting Started with Heat and Moisture Exchangers (HMEs) for Tracheostomy Care

After a tracheostomy, the air you breathe in bypasses the natural humidification and warming functions of your upper airways. Instead, unconditioned air enters directly into your lungs via the opening in your neck or tracheostoma, which can impact the lungs’ health and proper functioning. An HME is a device that works in a similar way to your nose. The HME captures moisture and heat from the air you now breathe out through your neck and uses it to humidify and warm the air you breathe in, helping to maintain your lung health and comfort.

little girl with a tracheostomy on a swing

Breathing through a Tracheostoma

After your tracheostomy, you will breathe mainly through the tracheostoma in your neck. Inhaled air will bypass the upper airway’s natural humidification and warming functions, reaching your lungs cold dry, and unfiltered. This can cause more mucus, coughing, and risk of infections. An artificial method that conditions the air for you, such as an HME, is necessary to keep you comfortable and your lungs healthy with this new way of breathing.

What is an HME and how might it help?

A Heat and Moisture Exchanger (HME) is a device designed to function similarly to the human nose by conditioning the air that is inhaled. An HME attaches to the end of a tracheostomy tube and absorbs heat and moisture from the exhaled air. The HME retains the captured heat and moisture within its structure, then releases it into the inhaled air. This process repeats with each breath, ensuring the air entering the lungs is consistently conditioned which helps to maintain the moisture and temperature necessary for respiratory health.

Why would you benefit from using an HME?

An HME can help compensate for not breathing through your nose and mouth. Improvements in lung health and quality of life have been observed in patients wearing an HME because the HME can help reduce mucus, coughing, and airway irritation.

There are various HMEs designed for different situations, including day and night use. Some combine a one-way valve for hands-free speech, others allow oxygen supply, and some provide protection against bacteria and viruses. Consult your clinician to find the right HME for you.

How to start using an HME

Perform hand hygiene, then gather your HME and ensure it is clean and ready for use. Securely attach the HME to the end of the tracheostomy tube. The HME typically has a universal connector that fits most tracheostomy tubes. The HME remains on the end of the tube, and you breathe in and out through it. HMEs should be worn as close to 24 hours a day as possible. You may select different HMEs based on your activities and guidance from your healthcare provider (See chapter on types of HMEs).

1. Build up your tolerance

Pay attention to how you feel when using an HME. Initially, you may feel an increase in the effort required to breathe as the HME may impose more resistance. This is to be expected. It may be helpful to use the HME for brief periods at first to adjust to this new resistance.

2. Take slow and calm breaths

Begin by wearing your HME in a calm and relaxed state. Initially, it is advisable to sit quietly for a period to maintain a low breathing rate. Breathe normally through the HME and gradually increase your level of activity thereafter.

3. Replace your HME regularly

If you experience increased effort in breathing or discomfort, check your HME. It may be blocked with mucus or debris and require replacement. HMEs are generally disposable and should not be cleaned for reuse. Replace your HME at least every 24 hours or more often as needed.

4. Expect improvements in symptoms

You may experience less coughing and less mucus over time with consistent HME use. Pay attention to your comfort level when wearing an HME and report any concerns such as persistent breathing or mucus changes, discomfort, or fatigue to your HCP.

Care Tip video

How-to videos that provide you with detailed instructions on using and managing our devices through a step-by-step approach.

How to Attach and Remove a Heat and Moisture Exchanger (HME)

Benefits of wearing an HME

An HME can compensate for not breathing through the nose and mouth. Improvements in lung health and quality of life have been observed in patients wearing an HME. This is because the HME can help to reduce mucus, coughing, and feeling irritation in the airway.

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Keeping your airways healthy

To improve or maintain your lung health, you should use your HME continuously for 24 hours a day.

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Day and night humidification

24/7 HME use is important. This includes sleeping with HME, to optimize your lung health.

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Less coughing

The HME warms and humidifies the air, aiding lung function and reducing mucus and coughing.

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Protection from viruses and bacteria

HMEs may include an electrostatic filter to decrease the inhalation of viruses and bacteria, e.g. Freevent XtraCare.

HME considerations

    • To use an HME that attaches to the end of your tracheostomy tube, you must be able to breathe on your own and be able to remove and replace the HME independently. If not, you must have constant supervision while wearing the HME.
    • Do not wear the HME at the same time as you are using an external humidifier or nebulizer.
    • HMEs can be worn with a cuffless tracheostomy tube or a cuffed tracheostomy tube with the cuff inflated. However, if the HME has a speaking function or a one-way speaking valve, the cuff must always be deflated or preferably, a cuffless tube must be worn.
    • Monitor your secretions and stop using the HME if you notice your mucus amount has significantly increased or become thicker. Switch to a different method of humidification and notify your healthcare provider.
    • If you have difficulty breathing while wearing an HME, remove the HME, then attempt to cough to expel mucus or suction. If breathing difficulty persists, call for help and follow emergency protocol.

    Explore HMEs

    An HME can provide an effective and discrete method of humidification, allowing freedom of movement while still providing adequate heat and moisture to lower respiratory tract. We offer a range of HMEs with different features suitable for different patient needs and situations.

    Learn more:

    Rerefences

    • de Kleijn BJ, van As-Brooks CJ, Wedman J, van der Laan BFAM. Clinical feasibility study of protrach dualcare a new speaking valve with heat and moisture exchanger for tracheotomized patients. Laryngoscope Investigative Otolaryngology. 2017;2(6):453-8.
    • Mercke U, Toremalm NG. Air humidity and mucociliary activity. Ann Otol Rhinol Laryngol. 1976 Jan-Feb;85(1 Pt 1):32-7
    • Parrilla C, Minni A, Bogaardt H, Macri GF, Battista M, Roukos R, Pandolfini M, Ruoppolo G, Paludetti G, D’Alatri L, de Vincentiis M. Pulmonary Rehabilitation After Total Laryngectomy: A Multicenter Time-Series Clinical Trial Evaluating the Provox XtraHME in HME-Naïve Patients. Ann Otol Rhinol Laryngol. 2015 Sep;124(9):706-13.
    • Thomachot L, Viviand X, Arnaud S, Vialet R, Albanese J, Martin C. Preservation of humidity and heat of respiratory gases in spontaneously breathing, tracheostomized patients. Acta Anaesthesiol Scand. 1998 Aug;42(7):841-4.
    • Vitacca M, Clini E, Foglio K, Scalvini S, Marangoni S, Quadri A, et al. Hygroscopic condenser humidifiers in chronically tracheostomized patients who breathe spontaneously. Eur Respir J. 1994;7(11):2026-32.
    • Williams R, Rankin N, Smith T, Galler D, Seakins P. Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa. Crit Care Med. 1996;24(11):1920-9
    • Zuur JK, Muller SH, de Jongh FH, Van ZN, Hilgers FJ. The physiological rationale of heat and moisture exchangers in post-laryngectomy pulmonary rehabilitation: a review. Eur Arch Otorhinolaryngol. 2006;263(1):1-8.

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