Decrease in Respiratory Related Hospitalizations in Tracheostomy-Dependent Children Who Tolerate Passy-Muir Valve Use

Abstract

Objective: To assess the effect of Passy-Muir® Valve (PMV) tolerance on respiratory illness and respiratory related hospital admissions in tracheostomy-dependent children. Methods: Retrospective cohort study of 262 patients who underwent tracheostomy placement between 2012 and 2018 at a tertiary free-standing children’s hospital. Outcome measures studied were number of reported upper respiratory infections and respiratory related hospitalizations per year (RRH/year). Results: About 135 (51.5%) tracheostomy-dependent children underwent PMV trials, and 106 (78.5%) of these children were able to tolerate PMV for at least 1 hour daily. When comparing children who tolerated PMV versus those who did not, the latter group had significantly higher rates of subglottic stenosis but no significant differences in RRH/year or average age. In those children who tolerated PMV and achieved routine use of PMV > 1 hour/day, an average of 1.14 RRH/year occurred prior to PMV tolerance, as compared with 0.57 RRH/year after PMV tolerance ( P = .003). Multivariate analysis shows that in patients <2 years, there is a significant decrease in RRH/year after PMV tolerance is attained (1.53 vs 0.76, P = .001), independent of indication for tracheostomy. Conclusion: In tracheostomy-dependent children who tolerate PMV use routinely >1 hour/day there are decreased rates of respiratory related hospitalizations (RRH). Children <2 years of age have the most impact of RRH, with rates that are significantly lower with routine use of the PMV.

Factors Related to the Incidence of Dysphagia in Patients Using Tracheal Cannula at Dr. Mohammad Hoesin General Hospital Palembang

“…Even with increasing age, muscle strength remains the same. 18 Poor nutritional status is considered a cause and effect of dysphagia due to inadequate oral intake.…”

Pediatric tracheostomy surveillance

“…It is thought this may restore laryngeal sensation and muscular movements possibly contributing to swallow function as well. 9 Poor PMV tolerance is also associated with excessive transtracheal pressure on exhalation and suggestive of upper airway obstruction. 10 In the case of this patient, key opportunities for intervention were likely missed secondary to losing the patient to follow-up.…”

“…These speaking valves have been shown to improve phonation and speech development in children by increasing subglottic pressure and airflow through the larynx. It is thought this may restore laryngeal sensation and muscular movements possibly contributing to swallow function as well 9 . Poor PMV tolerance is also associated with excessive transtracheal pressure on exhalation and suggestive of upper airway obstruction 10 …”

Benefícios da Válvula de fala em crianças traqueostomizadas: uma revisão integrativa

“…Em uma pesquisa, relacionaram primeiro grupo de crianças que tolerava a válvula Passy-muir por pelo menos 1 hora com um que não tolerava e identificaram aumento de estenose subglótica no segundo grupo, e no grupo com a válvula houve redução nas taxas de hospitalizações (Li, Lilum., Wikner, Behzadpour, Perez, & Mudd, 2020).…”