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. 2024 Feb;138(2):216-223.
doi: 10.1017/S0022215123001068. Epub 2023 Jun 21.

Maximal cardiopulmonary exercise testing in laryngectomised patients using different heat and moisture exchangers - feasibility and exercise responses

Anne N Heirman  1 , Wim G Groen  2 , Lisette van der Molen  1 , Richard Dirven  1 , Michiel W M van den Brekel  1   3 , Martijn M Stuiver  1   2   4   5
Affiliations

Maximal cardiopulmonary exercise testing in laryngectomised patients using different heat and moisture exchangers - feasibility and exercise responses

Anne N Heirman et al. J Laryngol Otol. 2024 Feb.

Abstract

Objective: After laryngectomy, the breathing resistance of heat and moisture exchangers may limit exercise capacity. Breathing gas analysis during cardiopulmonary exercise testing is not possible using regular masks. This study tested the feasibility of cardiopulmonary exercise testing with a heat and moisture exchanger in situ, using an in-house designed connector. Additionally, we explored the effect of different heat and moisture exchanger resistances on exercise capacity in this group.

Methods: Ten participants underwent two cardiopulmonary exercise tests using their daily life heat and moisture exchanger (0.3 hPa or 0.6 hPa) and one specifically developed for activity (0.15 hPa). Heat and moisture exchanger order was randomised and blinded.

Results: All participants completed both tests. No (serious) adverse events occurred. Only four subjects reached a respiratory exchange ratio of more than 1.1 in at least one test. Maximum exercise levels using heat and moisture exchangers with different resistances did not differ.

Conclusion: Cardiopulmonary exercise testing in laryngectomees with a heat and moisture exchanger is feasible; however, the protocol does not seem appropriate to reach this group's maximal exercise capacity. Lowering heat and moisture exchanger resistance does not increase exercise capacity in this sample.

Keywords: Laryngectomy; exercise training; head and neck cancer.

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Conflict of interest statement

None declared

Figures

Figure 1.
Figure 1.
The three-dimensional printed connector. (a) The inside of the connector; the arrow shows where the heat and moisture exchanger (HME) is placed. (a & c) This part is connected to the patient's stoma by placing it into the adhesive baseplate. (b & d) This part is connected to the computer for breathing gas analysis. As visible in parts (c) and (d), the two parts can be connected by sliding and locking it.
Figure 2.
Figure 2.
Cardiopulmonary exercise testing set-up. A study participant connected to a breathing gas analyser while seated on the exercise bicycle. Published with patient's permission.
Figure 3.
Figure 3.
Intra-subject comparison for peak workload (W peak) (a) and peak oxygen uptake (VO2 peak) (b) between the different heat and moisture exchanger resistances. Regular heat and moisture exchanger resistance (of 0.3 hPa or 0.6 hPa) is compared to lower resistance (0.15 hPa). The dashed line is the identity line.
See this image and copyright information in PMC

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