Effect of a Tracheostomy Speaking Valve on Secretions, Arterial Oxygenation, and Olfaction: A Quantitative Evaluation

Lichtman, Steven W.; Birnbaum, Ingrid L.; Sanfilippo, M.; Pellicone, John T.; Damon, William J.; King, Marjorie L.

doi:10.1044/jshr.3803.549

Cited by 66 publications

(51 citation statements)

References 10 publications

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“…This could suggest that the differences observed in the characteristics of the phonation valves have little clinical impact. This is in accordance with previous studies that have subjectively and clinically evaluated phonation valves [30][31][32][33]. However, the limited duration of the evaluation may underestimate the potential fatigue induced by the additional WOB resulting from the use of the phonation valves.…”

Section: Discussionsupporting

confidence: 78%

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Characteristics of tracheostomy phonation valves

Prigent¹,

David²,

Mb³

et al. 2006

Eur Respir J

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Phonation valves are commonly used devices that allow the restoration of speech in tracheostomised patients. However, their use should not compromise the physiological benefit of tracheostomy.Six commercialised phonation valves were studied in a dynamic set-up simulating a respiratory frequency of 20 breaths?min . Additional WOB varied with a ratio of 4.4 between the best and the worst valve. While the different clinical conditions did not modify respiratory patterns and gas exchanges, a significant effect on the Borg scale rating was observed using ANOVA and post hoc analysis of baseline versus worst valve and one of the best valves versus worst valve.In conclusion, the variety of aerodynamic characteristics of phonation valves should be considered when choosing the device, according to the underlying condition of the patients benefiting from their use.

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Section: Discussionsupporting

confidence: 78%

“…Several studies have evaluated the tolerance of these phonation valves, but were mainly based on clinical and subjective criteria [30][31][32][33]. In the current study, while the valves were clinically rather well tolerated, a significant influence of the type of phonation device on the sensation of respiratory difficulty was observed.…”

Section: Discussionmentioning

confidence: 76%

Characteristics of tracheostomy phonation valves

Prigent¹,

David²,

Mb³

et al. 2006

Eur Respir J

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“…Like capping, speaking valves also have benefits in addition to phonation, including fewer secretions, improved swallow, cough, Valsalva maneuver, and restoration of intrinsic positive end-expiratory pressure. 25 Patients who do not tolerate capping may require a smaller tube, or they may have some other obstruction within the airway such as paralyzed vocal cords. These patients may require further bronchoscopic evaluation to determine the cause of the obstruction.…”

Section: Step 7: Capping Trialsmentioning

confidence: 99%

The Importance of Tracheostomy Progression in the Intensive Care Unit

Morris

McIntosh

Whitmer

2014

Critical Care Nurse

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T racheostomy is now considered a common procedure, 1 and so it is important for nurses to become knowledgeable about tracheostomy progression, beginning immediately postoperatively and continuing through long-term care. Most tracheostomies placed in patients in intensive care units (ICUs) are done in order to facilitate weaning from mechanical ventilation. After the patient has been liberated from mechanical ventilation and the need for the tracheostomy is resolved, there should be a plan to progress toward decannulation. Daily evaluation of the progress toward decannulation can reduce length of stay, infection rates, and overall health care costs. [2][3][4][5] In this article, we review a systematic method for tracheostomy progression and describe how critical care nurses can facilitate this process. FeatureA plan to progress a tracheostomy toward decannulation should be initiated unless the tracheostomy has been placed for irreversible conditions. In most cases, tracheostomy progression can begin once a patient is free from ventilator dependence. Progression often begins with cuff deflation, which frequently results in the patient's ability to phonate. A systematic approach to tracheostomy progression involves assessing (1) hemodynamic stability, (2) whether the patient has been free from ventilator support for at least 24 hours, (3) swallowing, cough strength, and aspiration risk, (4) management of secretions, and (5) toleration of cuff deflation, followed by (6) changing to a cuffless tube, (7) capping trials, (8) functional decannulation trials, (9) measuring cough strength, and (10) decannulation. Critical care nurses can facilitate the process and avoid unnecessary delays and complications. (Critical Care Nurse. 2014;34[1]:40-50) This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Discuss a systematic method for tracheostomy progression 2. Describe how critical care nurses can facilitate the process of decannulation 3. List outcomes achieved with a standardized clinical practice guideline for tracheostomy patients

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“…By restoring the airflow through the upper airway, return of subglottic pressure during swallowing is facilitated [164]. Improved taste and smell have also been reported [152,165]. However, it is unclear if this is necessary for a successful swallow.…”

Section: Swallowingmentioning

confidence: 99%

“…An in-line SV is a one-way valve that blocks airflow from returning to the ventilatory circuit, and redirects it through to the upper airway enabling functional use of the glottis [152] This may be deleterious to liberating patients from the ventilator and prolong their length of stay in ICU. There is currently no published research documenting the effect of talking with a deflated cuff (leak speech) or SV on EELV, and limited research documenting the effect of leak speech or SVs on weaning from mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

Sutt¹

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Tracheostomised mechanically ventilated patients are often left unable to speak, which is frustrating for patients and the staff caring for them. Having no voice causes major distress and feelings of helplessness for patients. Voicelessness frequently leads to reduced information exchange between the patient and healthcare team, frequently to the detriment of patient care. An in-line speaking valve (SV) is a one-way valve that may be used in the mechanical ventilation circuit to enable verbal communication in tracheostomised patients.Limited data exist regarding the effect of SVs on respiratory mechanics. Deflation of the tracheostomy cuff is required for placement of the SV, effectively causing a "leak" in the As an experienced speech pathologist, I believe concerns over SV use to date have little evidence. The main objective, and first aim of this thesis was to investigate the effect of SV use on respiratory mechanics to determine whether SVs should be used in-line with mechanical ventilation of tracheostomised patients. The second aim was to assess the effect of introducing SVs into a cardio-thoracic ICU on patient tracheostomy specific outcomes. The third aim was to further clarify the effect of SVs on success with healthrelated communication for ICU patients. To achieve these aims, 5 studies were conducted, resulting in 5 manuscripts.For the first aim, 20 tracheostomised ICU patients using a SV that met the inclusion criteria were recruited to the study from November 2013-December 2014. Electrical Impedance iii Tomography (EIT) was used to assess the patients' end-expiratory lung impedance (EELI) and ventilation distribution continuously over 60 minutes (before, during and after SV use). For the third aim, 25 patients and 52 nursing staff were asked to fill out a custom-made questionnaire on success with health communication, firstly when the patients were voiceless, and, secondly, when they were using a SV. Chapter 7 highlights individual differences and some disparity between patient and nursing ratings of communication success. Overall, however, following SV use both the patients and nursing staff reported a significant improvement in success with health communication. Additional variables included oxygenation (SpOIn conclusion, the findings of this thesis addressed the research aims, and provide new knowledge through use of an innovative approach to assessing lung mechanics. Having iv already resulted in real clinical changes in our centre, the results indicate the potential for optimising communication, using SVs in tracheostomised cardiothoracic ICU patients undergoing weaning from mechanical ventilation.v

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Effect of a Tracheostomy Speaking Valve on Secretions, Arterial Oxygenation, and Olfaction: A Quantitative Evaluation

Cited by 66 publications

References 10 publications

Characteristics of tracheostomy phonation valves

Characteristics of tracheostomy phonation valves

The Importance of Tracheostomy Progression in the Intensive Care Unit

Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

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