216 | Chapter 9 on symptoms and quality of life16. Aside from differences in experienced comfort, it is currently unknown to what extent differences in HME resistance influence acute exercise responses, and exercise capacity and performance. To understand the differences between HMEs in terms of their impact on exercise tolerance and exercise response, exercise testing is required. The gold standard for cardiopulmonary exercise testing is a maximal Cardiopulmonary Exercise Test (CPET) with breathing gas analysis17–19. In patients after TL, this is complicated since the regular facial masks used for breathing gas analysis cannot be used. Previously, exercise testing using a custom-made adapter attached to the base plate of the HME, but without the HME being in-place, proved to be feasible20,21. However, this approach discards the effect of the HME on upper airway physiology. In addition, it creates an unnatural situation for patients, which may impact the results of exercise testing. To enable research into the impact of an HME’s resistance on exercise capacity, we developed an adapter that allows exercise testing with the HME in situ. In this exploratory study, we tested the feasibility of this set-up for CPET in ten laryngectomized patients and explored the influence of HME resistance on their exercise capacity and performance.
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