Introduction | 27 1 Heat and Moisture Exchangers Respiratory rehabilitation after TL is essential due to the separation of the upper and lower respiratory tracts, fundamentally altering the airway dynamics. After the surgery, the natural functions of the upper airway—warming, humidifying, and filtering the inhaled air—are bypassed as breathing is redirected through a stoma directly into the lower airways. This loss leads to increased pulmonary symptoms such as involuntary coughing, mucus retention, and forced expectoration. Furthermore, patients are at a higher risk of airway infections and inflammations, affecting not only their physical health but also their sleep, social interactions, and overall quality of life68–72. To mitigate these challenges, two primary devices have been developed: stoma cloth covers (bib) and Heat and Moisture Exchangers (HMEs). While bibs are a cost-effective solution offering potentially good air conditioning, they pose challenges in stoma occlusion for speech and are generally less favored by patients73. Consequently, HMEs have become the preferred choice in many developed countries due to their efficiency in retaining heat and moisture from exhaled air and transferring it to the inhaled air, significantly improving the tracheal climate, reducing coughing and sputum production, and enhancing patients’ quality of life68,74–76.These devices, attached via an adhesive baseplate or cannula over the stoma, have shown efficacy in long-term use by preventing the deterioration of tracheal cells and even restoring them. Despite the benefits, the performance of HMEs is balanced against their resistance, which can vary based on the device’s size and internal specifications. Higher resistance HMEs, while more effective in air conditioning, may cause discomfort during physical activities, potentially discouraging physical exercise and impacting overall health and quality of life negatively77. The choice of HME, therefore, should consider individual patient needs, lifestyle, and the specific level of activity to ensure optimal compliance and enhance the quality of life. With a range of HMEs available, tailored to offer varying levels of resistance and humidification, it’s crucial for patients to find a balance that supports their respiratory health without compromising their activity levels and overall well-being78. Cardiopulmonary exercise testing Maximal Cardiopulmonary Exercise Testing (CPET) is a valuable tool in rehabilitation, offering insights into patients’ cardiovascular and pulmonary health, as well as overall physical fitness. It is typically conducted in a controlled clinical setting under the supervision of healthcare professionals. During the test, patients are instructed to perform incremental exercise on a stationary cycle or treadmill. The intensity of exercise gradually increases in predetermined stages or through continuous ramp protocols79.
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