From Evidence to Practice: Standardizing Tracheostomy HME Use in the Hospital
The Role of Artificial Humidification
In patients with a tracheostomy, the upper airway is bypassed, eliminating the natural warming and humidifying functions of the nose and nasopharynx. Without adequate humidification, patients are at increased risk for thick secretions, mucus plugging, and pulmonary complications, making artificial humidification an essential component of care.1,2
Two primary humidification approaches are used in clinical practice: active external humidification and heat and moisture exchangers (HMEs). Active external humidification delivers humidified air through tubing and a tracheostomy collar / mask, requiring multiple components, electricity, and on-going maintenance. In contrast, HMEs attach directly to the tracheostomy tube and work by conserving heat and moisture from exhaled air, returning it during inspiration.3
Although active external humidification has been commonly used in hospital settings, its limitations — including noise, restricted mobility, inconsistent delivery, increased setup time, and reduced patient tolerance — have prompted interest in more patient-centered solutions.
HME illustration showing heat and moisture retention during exhalation and release during inhalation.
The Case for HMEs
HMEs have long been considered the gold standard in laryngectomy care, with evidence showing improved pulmonary health, reduced coughing, and better secretion management compared to no humidification or external systems. 4,5 These benefits are now increasingly recognized for patients with tracheostomies. Comparative studies show that HMEs are favored over active external humidification because they are easier to set up, improve patient mobility, simplify caregiver education, and lower overall cost.6 In addition, systematic reviews indicate that passive humidification with HMEs is associated with fewer pulmonary complications and better patient tolerance than active external systems when used in appropriate populations.7
Among the HMEs increasingly used for spontaneously breathing patients with tracheostomies, TrachPhone HME stands out for its combination of effective humidification and multifunctional features. It has a hygroscopic foam core for optimal performance, and includes a speech valve, O₂ port, and suction port. These features make TrachPhone a practical and versatile choice for both patients and staff.
Why Consistency in HME Use Matters
Despite evidence about the numerous HME advantages, tracheostomy HME use often varies by unit, provider preference, or historical practice. This variability may lead to inconsistent care, staff confusion, and missed opportunities to optimize outcomes.
Standardizing HME use promotes evidence-based, patient-centered care while improving continuity across units. It simplifies clinician and caregiver education, supports more predictable workflows, and reduces unnecessary equipment use. Achieving this level of consistency requires a deliberate, structured approach to practice change.
Driving Practice Change
Successful implementation involves more than introducing a new product. It requires engaging people, aligning processes, and sustaining momentum. Kotter’s 8-Step Change Model provides a practical framework for guiding practice change, from establishing urgency and building a guiding coalition to embedding new practices into organizational culture.8
Key strategies include engaging multidisciplinary stakeholders, providing targeted education, addressing workflow barriers, and creating early “wins” through pilot programs. As momentum builds, standardized HME use can be incorporated into protocols, order sets, and routine practice, supporting long-term sustainability.
Next Steps
Healthcare providers seeking to standardize HME use can begin by engaging key stakeholders across nursing, respiratory therapy, physicians, speech-language pathology, and supply chain. Piloting HME use and evaluating outcomes can inform broader implementation and support a transition toward more consistent, patient-centered humidification practices.
To make this change easier, Atos Medical offers the TrachPhone Implementation Program, a structured initiative led by our Tracoe Sales Specialists and Clinical Education team. The program provides support and resources to help healthcare teams integrate TrachPhone HME into daily practice. Specifically, it aims to:
- Partner with healthcare teams to guide adoption of TrachPhone HME and overcome barriers.
- Offer hands-on support to make HME implementation practical and achievable.
- Assist facilities in translating evidence into practice through structured TrachPhone HME implementation.
The program includes a range of educational resources to support staff and patients, including staff guidelines, patient and family CareTips, Head-of-Bed signage, a comprehensive implementation handbook, an educational video for staff training, and both virtual and on-site support.
To learn more about the TrachPhone Implementation Program and how we can support your team in adopting HMEs, please contact your Tracoe Sales Specialist or reach out info.us@atosmedical.com.
Upcoming webinar
Webinar title: Optimizing Outcomes with Standardized Tracheostomy & Laryngectomy HME Use
Date: Tuesday, March 24, 2026
Time: 12:00pm - 1:00pm CT
CEUs offered: AHSA CEUs - 0.1
Course description: This course reviews pulmonary rehabilitation and humidification for patients with surgical airways using heat and moisture exchangers (HMEs). Attendees will compare HME types, examine evidence-based practices and gain practical strategies for integrating HMEs across care settings from hospital to home to optimize patient outcomes.
REGISTER NOW
References:
1. Intensive Care Society Standards. Tracheostomy Care. London (UK): Intensive Care Society; 2014. Available from: https://ics.ac.uk/asset/E0B8C2B2-2B70-4A18-839EB859969DBB74/
2. Tracheostomy.org.uk. Day-to-day management of tracheostomies and laryngectomies: Humidification. UK: National Tracheostomy Safety Project; 2025. Available from: https://tracheostomy.org.uk/storage/files/HumidificationNew.pdf
3. American Association for Respiratory Care. Clinical Practice Guideline: Humidification during invasive and noninvasive mechanical ventilation. AARC; 2012. Available from: https://www.aarc.org/wp-content/uploads/2014/08/12.05.0782.pdf
4. Zuur JK, Muller SH, de Jongh FH, et al. The physiological rationale of heat and moisture exchangers after total laryngectomy. Eur Arch Otorhinolaryngol. 2006;263(1):1–8.
5. Kearney A, Chen J, Walsh BK. Comparison of heat and moisture exchangers versus active humidification in spontaneously breathing tracheostomy patients. Respir Care. 2023;68(4):512–520.
6. Wong DT, Tam AD, Van Zundert AAJ. Passive versus active humidification in patients with surgical airways: a systematic review. Anesth Analg. 2016;122(6):1740–1750.
7. Kotter JP. Leading Change. Boston (MA): Harvard Business Review Press; 2012.