Active versus passive humidification for self-ventilating tracheostomy and laryngectomy patients: a systematic review of the literature

Abstract

Objective: To determine whether active or passive humidification methods are more effective in preventing pulmonary complications in self-ventilating neck breather patients.

Design: Systematic Review adhering to PRISMA guidance (checklist sourced from www.equator-network.org/).

Setting: Review of current published relevant literature at a tertiary department of Otolaryngology and Head & Neck Surgery.

Participants: We included all separate studies and comparison studies of active and passive humidification techniques in adult and paediatric neck breather patients.

Main outcome measures: The primary outcome is the reduction in pulmonary complications. Secondary outcomes include patient compliance; carer and user satisfaction.

Results and conclusions: Seven studies were included in this review: two RCTs (133 patients), one randomised controlled cross-over trial (29 patients), three randomised prospective studies (171 patients), and one retrospective study (73 patients). Only one study was conducted on paediatric neck breathers. The overall quality of the studies was low. Five studies were at a high risk of bias. Of the remaining two studies, one study had a low risk of bias and the other had an unclear risk. Despite limited subject evidence, results show that passive methods of humidification (mainly HME) is the preferred choice of humidification in the spontaneously breathing neck breather patients group mainly due to the reduction in pulmonary complaints, and better patient compliance.