Arquivo da tag: speaking valve

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.
ABSTRACT:
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.

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.
ABSTRACT:
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.

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
ABSTRACT
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.

Effect of the Passy‐Muir valve on aspiration in patients with tracheostomy

Mark A. Dettelbach, Roxann D. Gross MA, Jeanne Mahlmann, David E. Eibling

Head & neck, 2006 – Wiley Online Library

Abstract

Objective. To assess potential benefit of a Passy-Muir Speaking Valve (PMV) in decreasing aspiration in patients with a tracheostomy.

Background. Many patients with tracheostomy exhibit clinically significant aspiration. It has been previously noted that aspiration can often be reduced or eliminated by plugging or removing the tracheostomy tube. Some patients, however, do not tolerate removal or plugging of their tracheostomy tube, which then leads to persistent aspiration. We postulated that a one-way speaking valve may restore more normal subglottic and glottic air flow and reduce aspiration.

Methods. Alert patients with a tracheostomy and clinical evidence of aspiration were eligible for study. Eleven patients with tracheostomy and known aspiration were studied with a modified barium swallow. Radiographic examination was used to evaluate the presence and amount of aspiration while patients swallowed both with and without a PMV in place on their tracheostomy tube.

Results. Aspiration was reduced (or eliminated) during swallowing in all 11 patients when they wore a PMV, when compared to swallowing with an open (unvalved) tube. This improvement was achieved with liquids, semisolids, and pureed consistencies.

Conclusion. This study demonstrates that a Passy-Muir speaking valve facilitated swallow and reduced aspiration in patients with a tracheostomy and known aspiration.

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