Linear versus Turbulent Airflow Tracheostomy Heat and Moisture Exchangers: A Crossover Study

Objective This study aimed to evaluate the impact of two tracheostomy heat and moisture exchangers (HMEs), namely the Shikani Oxygen HME™ (S‐O 2 HME, ball type, turbulent airflow) and Mallinckrodt Tracheolife II DAR HME (M‐O 2 HME; flapper type, linear airflow) on tracheobronchial mucosal health, oxygenation, humidification, and patient preference. Methods A randomized cross‐over study was conducted with HME‐naïve long‐term tracheostomy subjects at two academic medical centers. Bronchoscopy assessments of mucosal health were performed at baseline and day 5 of HME application, along with oxygen saturation (S pO2 ) and breathed air humidity at four oxygen flow rates (1, 2, 3, and 5 lpm). Patient preference was assessed on study conclusion. Results Both HMEs were associated with improved mucosal inflammation and decreased mucus production ( p < 0.0002), with greater improvements in the S‐O 2 HME group ( p < 0.007). Both HMEs improved humidity concentration at each oxygen flow rate ( p < 0.0001), without significant differences between groups. S pO2 was greater for the S‐O 2 HME versus the M‐O 2 HME across all measured oxygen flow rates ( p = 0.003). At low oxygen flow rates (1 or 2 lpm), the S pO2 in the S‐O 2 HME group was similar to that of the M‐O 2 HME at higher oxygen flow rates (3 or 5 lpm; p = 0.6). Ninety percent of subjects preferred the S‐O 2 HME. Conclusion Tracheostomy HME uses correlated with improved indicators of tracheobronchial mucosal health, humidity, and oxygenation. The S‐O 2 HME outperformed the M‐O 2 HME with respect to tracheobronchial inflammation, S pO2 , and patient preference. Regular HME use by tracheostomy patients is recommended to optimize pulmonary health. Newer ball‐type speaking valve technology additionally allows concomitant HME and speaking valve application. Level of Evidence 2 Laryngoscope , 133:3422–3428, 2023