Pediatric tracheostomy speaking valves: A multidisciplinary protocol leads to earlier initial trials

Abstract

Early speaking valve application in children with tracheostomies is encouraged for language development. Whether an institutional multidisciplinary protocol impacts the patient population and timelines for which a speaking valve is trialed has not been studied. This retrospective study compared speaking valve trials performed at a pediatric quaternary hospital over a 12-year period. Timelines (time between tracheostomy insertion, speech-language pathologist (SLP) consultation, speaking valve order, and trial) and patient characteristics (demographics, tracheostomy classification, and feeding status) were collected. Medians (IQRs) compared timelines before and after a protocol was instituted and compared the timelines between tracheostomy classifications. Median time between tracheostomy insertion and SLP consultation did not change: before protocol-1.8 (7.7) months and after protocol-1.8 (2.4) months. Time between tracheostomy insertion and speaking valve trial decreased: before protocol-34.1 (40.5) months and after protocol-12.9 (8.4) months. Time between tracheostomy insertion and trial was not different between tracheostomy classifications: upper airway obstruction-16.0 (27.1) months, complex medical condition-36.3 (45.8) months, and invasive ventilation-17.5 (22.3) months. An institutional multidisciplinary protocol decreases the time between tracheostomy insertion and speaking valve trial, regardless of the reason the tracheostomy is needed in the pediatric population.

Chronic tracheostomy care of ventilator‐dependent and ‐independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system

“…10,27 In accordance with clinical practice guidelines, we would advocate for formal evaluation by speech and language pathology in a standardized fashion, ideally before tracheostomy tube insertion, for the development of a communication treatment plan to optimize communication and speech acquisition in all children undergoing tracheostomy. 14,16,28 Though consensus was rare, there were a few areas of consistent practice across the country. In general, the use of cuffed tracheos- In the domain of decannulation, the only area of consensus was the need for endoscopic confirmation of airway patency as a means of determining readiness of decannulation.…”

“…This disparity in care suggests the importance of a multi‐disciplinary tracheostomy team, as the presence of such teams has been associated with the increased use of speaking valves and speech assessments in adult patients 10,27 . In accordance with clinical practice guidelines, we would advocate for formal evaluation by speech and language pathology in a standardized fashion, ideally before tracheostomy tube insertion, for the development of a communication treatment plan to optimize communication and speech acquisition in all children undergoing tracheostomy 14,16,28 …”