Pulmonale Rehabilitation nach totaler Laryngektomie durch die Verwendung von HME (Heat Moisture Exchanger)

 

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Zusammenfassung

Die komplette Entfernung des Kehlkopfes hat tiefgreifende Folgen für die betroffenen Patienten. Die Laryngektomie bedeutet die Unterbrechung der oberen und unteren Atemwege und führt somit nicht nur zu einem Verlust des stimmbildenden Organs sondern induziert ebenso chronische pulmonale Beschwerden wie häufiges Husten, verstärkte Sputumproduktion und verstärkte Expektorationen. Weiterhin werden von laryngektomierten Patienten Beschwerden hinsichtlich Müdigkeit und Schlafproblemen, einer Beeinträchtigung des Geruchs- und Geschmackssinns sowie eingeschränkte Sozialkontakte genannt. Durch die Verwendung von HME-Kassetten (Heat Moisture Exchangers) soll die Konditionierungsfunktion der oberen Atemwege ersetzt werden. Die HME-Kassetten werden bei der Verbesserung der pulmonalen Symptomatik in drei Teilbereichen wirksam. 1. Zum einen wird durch den Wärme- und Flüssigkeitsaustausch das physiologische Klima im Bereich der tiefen Atemwege weitgehend wiederhergestellt. 2. Führt die Erhöhung des Atemwiderstandes bei Verwendung von HME-Kassetten zu einer Reduktion der dynamischen Atemwegskompression und somit zu einer Verbesserung der Lungenventilation 3. Übernehmen die HME-Kassetten zumindest für gröbere Partikel eine Filterfunktion der Atemluft. In dieser Übersichtsarbeit werden die aktuellen Erkenntnisse zur Lungenphysiologie nach Laryngektomie sowie der Einfluss von HME-Kassetten auf die Bereiche Atemwegsklimatisierung, Lungenfunktion sowie psychosoziale Beschwerden beleuchtet.

Abstract

Pulmonary Rehabilitation after Total Laryngectomy using a Heat and Moisture Exchanger (HME)

A complete removal of the larynx has profound consequences for a patient. Since laryngectomy involves the separation of the upper airway from the lower airway, it not only implies a loss of the voice organ but also leads to chronic lung problems such as increased coughing, mucus production and expectoration. In addition, laryngectomees complain of fatigue, sleeping problems, a reduced sense of smell and taste, and a loss of social contact. A heat and moisture exchanger (HME) cassette can replace a function of the upper airway which consists in conditioning inspired air. It can improve pulmonary symptoms in three ways. 1. An HME cassette heats and moisturises inhaled air and thus creates nearly physiological conditions in the region of the deep airway. 2. The use of an HME cassette leads to an increase in breathing resistance, thereby reducing dynamic airway compression and improving lung ventilation. 3. An HME cassette acts as a filter and removes larger particles from incoming air. This review examines the current understanding of lung physiology after laryngectomy and assesses the effects of HME cassettes on the conditioning of respiratory air, lung function and psychosocial problems.

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Korrespondenzadresse

Dr. med. Kai J. LorenzOFA 

Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Halschirurgie

Bundeswehrkrankenhaus Ulm

Oberer Eselsberg 40

89081 Ulm

Email: kai.lorenz@extern.uni-ulm.de