Arquivo da categoria: Tracheostomy

Effects of one-way speaking valve placement on swallowing physiology for tracheostomized patients: impact on laryngeal clearance

Ohmae Y; Adachi Z; Isoda Y; Maekawa H; Kitagawa Y; Karaho T; Tanabe T; Kitahara S

Nihon Jibiinkoka Gakkai Kaiho; 109(7): 594-9, 2006 Jul.
Tracheostomy placement affects swallowing function, increasing the risk of aspiration. Recent studies suggest that because of increased risk of swallowing disturbance associated with tracheostomy, one-way speaking valve placement may help to reduce aspiration in tracheostomized patients. We hypothesize that airflow exhaled through the laryngeal cavity using the one-way speaking valve may improve the clearance of residual bolus from the upper airway, thus preventing bolus penetration and aspiration. We studied the effects of one way speaking valve placement on laryngeal clearance and swallowing physiology. Videoendoscopic and videofluoroscopic swallowing were examined in 16 patients with the tracheostomy, and swallowing was compared with and without the one-way speaking valve in place. Valve placement significantly improved laryngeal clearance and the incidence of penetration during swallowing. placement did not, however, significantly affect pharyngeal bolus residue, laryngeal elevation, pharyngeal delay or aspiration. Factors associated with the resumption of oral feedings were sufficient laryngeal elevation during swallow and the prevention of laryngeal penetration and aspiration. We concluded that one-way speaking valve placement improves laryngeal clearance and prevents laryngeal penetration, resulting in better oropharyngeal swallowing physiology and oral feeding.

Maintained expiratory airway pressure values as an indicator of tolerance of speaking valve in tracheostomized patients

Villarroel S, Gregory; Jalil C, Yorschua; Moscoso A, Gonzalo; Barañao G, Patricio; Astudillo M, Claudia; Chateau I, Bernardita; Méndez R, Mireya

Rev. chil. enferm. respir; 28(2): 104-108, jun. 2012. ilus, tab.
Introduction: Speaking valve (SV) is an unidirectional flow device installed over the tracheostomy tube allowing phonation. Tolerance to this device depends on the permeability of the upper airway (UA), which may be indirectly assessed by measuring UA maintained expiratory pressure (PEMant).
Objective: To evaluate the usefulness of the maintained expiratory pressure as a clinical indicator of tolerance to the SV.
Method: Twenty three tracheostomized patients (median age 22 months-old) were evaluated with an aneroid manometer during 15 minutes, recording PEMant, arterial oxygen saturation (SaO2),heart rate, respiratory rate, accessory muscle use and wheezing as signs of respiratory distress Results: PEMant values less than 10 cmH2O are associated with tolerance of the SV and values over 20 cmH2O are associated with intolerance.
Conclusion: Values under 10 cmH2O of PEMant can be used as an indicator of tolerance to VF.

Valores de presión espiratoria mantenida en la vía aérea como indicador de tolerancia al uso de válvula de fonación en pacientes traqueostomizados

Villarroel S, Gregory; Jalil C, Yorschua; Moscoso A, Gonzalo; Barañao G, Patricio; Astudillo M, Claudia; Chateau I, Bernardita; Méndez R, Mireya
Rev. chil. enferm. respir; 28(2): 104-108, jun. 2012. ilus, tab.
Introducción: La válvula de fonación (VF), es un dispositivo de flujo unidireccional instalado sobre la cánula de traqueostomía posibilitando la fonación. La tolerancia a este dispositivo depende de la permeabilidad de la vía aérea superior (VAS), pudiendo ser valorada indirectamente a través de la medición de la presión espiratoria mantenida (PEMant) en vía aérea. Objetivo: Estudiar esta técnica como indicador clínico de tolerancia a la VF. Método: Se evaluaron 23 pacientes traqueostomizados (mediana de edad 22 meses) con un manómetro aneroide durante 15 minutos, registrando PEMant, saturación arterial de oxígeno (SaO2), frecuencia cardiaca, frecuencia respiratoria, uso de musculatura accesoria y sibilancias para valorar la dificultad respiratoria. Resultados: Valores de PEMant menores a 10 cmH2O se asocian con tolerancia a la VFy valores sobre 20 cmH2O a intolerancia a ésta. Conclusión: Valores bajo 10cmH2O de PEMant pueden ser indicadores de tolerancia al uso de VF.

Optimizing speech production in the ventilator-assisted individual following cervical spinal cord injury: a preliminary investigation

MacBean N; Ward E; Murdoch B; Cahill L; Solley M; Geraghty T; Hukins C
Int J Lang Commun Disord; 44(3): 382-93, 2009 May-Jun.
BACKGROUND: Mechanical ventilation is commonly used during the acute management of cervical spinal cord injury, and is required on an ongoing basis in the majority of patients with injuries at or above C3. However, to date there have been limited systematic investigations of the options available to improve speech while ventilator-assisted post-cervical spinal cord injury. AIMS: To provide preliminary evidence of any benefits gained through the addition of positive end expiratory pressure (PEEP) and/or a tracheostomy speech valve to the condition of leak speech. METHODS & PROCEDURES: Speech production in the three conditions was compared in two ventilator-assisted participants using a series of instrumental and perceptual speech measures. OUTCOMES & RESULTS: The addition of PEEP or the use of a speech valve resulted in speech that was superior to leak speech for both participants; however, individual variation was present. CONCLUSIONS & IMPLICATIONS: Leak speech alone or with the addition of PEEP or a tracheostomy speech valve can facilitate functional communication for the ventilated patient, though PEEP and valve speech were found to be superior in the current study. These findings will be of assistance for clinicians counselling the growing population of patients who may require tracheostomy positive pressure ventilation long-term regarding communication options.

Outcome in tracheostomized patients with severe traumatic brain injury following implementation of a specialized multidisciplinary tracheostomy team

LeBlanc J; Shultz JR; Seresova A; de Guise E; Lamoureux J; Fong N; Marcoux J; Maleki M; Khwaja K
J Head Trauma Rehabil; 25(5): 362-5, 2010 Sep-Oct.
OBJECTIVE: To evaluate the effect of a specialized multidisciplinary tracheostomy team on outcome of patients with severe traumatic brain injury (sTBI).
DESIGN: Retrospective study with historical controls.
PARTICIPANTS: Twenty-seven patients with sTBI tracheostomized before implementation of the tracheostomy team approach and 34 patients followed by the team.
SETTING: A regional level 1 tertiary care trauma center, McGill University Health Centre-Montreal General Hospital. MAIN
OUTCOME MEASURES: Time to decannulation, length of stay (LOS), Passy-Muir speaking valve use, and extended Glasgow Outcome Scale (GOS-E) scores given at acute care discharge.
RESULTS: The groups were similar for injury severity, age, and premorbid health conditions. Postteam patients had a significantly shorter LOS (P = .025) and more of them used Passy-Muir speaking valves (P = .004). Furthermore, there was a trend toward decreased time to decannulation in the postteam group. GOS-E scores did not differ significantly between groups (P > .05).
CONCLUSION: Implementation of the tracheostomy team appears to have had positive clinical benefits for this population.

New tracheotomy speaking valve: a Brazilian proposal

Chone, Carlos T; Bortoleto, Antonio; Gripp, Flávio M; Crespo, Agricio N
Rev Bras Otorrinolaringol; 68(4): 546-549, jul.-ago. 2002. ilus, tab
Introduction: Tracheotomy is performed in conditions of upper airway obstruction or chronic pulmonary disorders. The use of tracheotomy speaking valves (TSV) has been described elsewhere but always at high cost for the patient, since all of them are imported.
Aim: To demonstrate the TSV manufactured in stainless steel, developed at the State University of Campinas, and the possibility of its use in speech rehabilitation of tracheotomized patients.
Study design: Clinical prospective.
Material and Methods: The TSV developed was used in ten consecutive patients. The valve works with a diaphragm inside a body made of stainless steel with plastic attachments. It directs the air to the larynx during phonation and allows introduction of air through the valve during inspiration, with low pressure.
Results: All ten patients are using the valve, speaking and breathing through it without distressing situations even during sleep.
Discussion: The TSV improves communication, intelligibility, hygiene and humidification of the airway. The psychological condition and amount of secretions in the airway are improved too. This TSV has a low cost and can benefit many patients in Brazil. Children who have had tracheotomy could have a delay in acquisition of language. The use of TSV might be helpful for the communication and social interaction of these children.
Conclusion: The TSV demonstrated is safe and allows effortless phonation without digital occlusion of the tube.

Nova válvula fonatória para traqueotomia: uma proposta brasileira

Chone, Carlos T; Bortoleto, Antonio; Gripp, Flávio M; Crespo, Agricio N
Rev Bras Otorrinolaringol; 68(4): 546-549, jul.-ago. 2002. ilus, tab
Introduçäo: A traqueotomia está indicada em condiçöes com obstruçäo respiratória alta ou doença pulmonar obstrutiva crônica. As válvulas fonatórias (VF) de traqueotomia já foram anteriormente descritas, porém apresentam alto custo para o paciente, pois säo todas importadas.
Objetivo: Demonstrar a VF, desenvolvida na Universidade Estadual de Campinas, confeccionada em aço inox, para cânula de traqueotomia e a possibilidade de sua utilizaçäo na reabilitaçäo fonatória desses pacientes. Forma de estudo: Clínico prospectivo.
Material e Método: A VF, desenvolvida na Universidade Estadual de Campinas, foi utilizada em dez pacientes consecutivos. A válvula tem diafragma dentro de um corpo em aço inox com encaixes de plástico. Ela permite o direcionamento do ar para a laringe durante a fonaçäo com oclusäo do traqueotoma e abertura do mesmo na inspiraçäo, sob baixa pressäo. Resultados: Atualmente dez pacientes estäo utilizando estas VF com fonaçäo sem necessidade de oclusäo do orifício externo da cânula e confortavelmente, inclusive durante o sono.
Discussäo: As VF para cânulas de traqueotomia melhoram a comunicaçäo, inteligibilidade, higienizaçäo e umidificaçäo das vias aéreas dos pacientes traqueotomizados. Há também melhora no aspecto emocional e diminuiçäo das secreçöes orais e traqueais. O custo de produçäo dessa VF nacional é baixo e milhares de pacientes poderäo ser beneficiados no Brasil. As crianças com traqueotomia podem apresentar retardo no desenvolvimento da linguagem. O uso da VF facilitará a comunicaçäo e a interaçäo social dessas crianças.
Conclusäo: A válvula fonatória metálica, desenvolvida na Universidade Estadual de Campinas, acoplada a uma cânula de traqueotomia metálica permite fonaçäo, sem a oclusäo digital da cânula, e respiraçäo sob conforto.