The Effect of Speaking Valves on ICU Mobility of Individuals With Tracheostomy

Abstract

BACKGROUND: Early mobilization is part of the rehabilitation process for critically ill patients and is currently considered a means of preventing ICU-acquired muscle deterioration and worsening of physical function. We sought to determine whether the use of speaking valves in tracheostomized patients would improve their mobility. We evaluated the changes in mobility performance with the use of speaking valves in tracheostomized subjects. METHODS: We performed a cohort study of a series of subjects who were tracheostomized and were being weaned from mechanical ventilation between April 2016 and May 2018. The subjects were those able to tolerate a speaking valve for a minimum of 30 min. Demographic data, comorbidities, cause of ICU admission, days in the ICU, duration of mechanical ventilation before tracheostomy, and days free from mechanical ventilation before tracheostomy were collected. Mobility status was evaluated using daily measurements of the Perme Intensive Care Unit Mobility Score. RESULTS: During the study period, 63 patients were tracheostomized. Patients with deficiencies in language (n ‫؍‬ 2) or cognitive deficits (n ‫؍‬ 36) and patients in exclusive palliative care (n ‫؍‬ 7) were excluded. Eighteen subjects were enrolled in the study. The mean age of the subjects was 64.6 ؎ 14.2 y (55.5% were male), and the most common reason for ICU admission was pneumonia (n ‫؍‬ 7; 38.8%). Perme scores increased from 11.3 (interquartile range 10.1-12.0) on the day before initiation of the speaking valve to 18.2 (IQR 16.2-20.1) immediately after the initiation of a speaking valve (P < .01). These changes were maintained during all periods of speaking valve use. CONCLUSIONS: The use of speaking valves in tracheostomized subjects improved mobility.

Enhancing Early Mobility With a Speaking Valve

“…DOI: 10.4187/respcare.07671 mobility scores. 8 Beyond this fact, the study results in a proof of concept due to both design and the small number of participants. Weaknesses include the fact that the authors did not validate the Perme score for subjects who had a tracheostomy.…”

“…9 After one day of using the speaking valve in conjunction with active early mobilization, the median Perme score increased from median and range, 11.3 (10.1-12.0) to 18.2 (16.2-20.1), P ¼ .01. 8 Changes to the Perme score after day 1 of mobility carried no statistical significance. Categorically, the subjects' ability to transfer from one position (eg, transfer from bed to chair) represented the biggest changes in the Perme score within this cohort.…”

“…Forty-five other patients were excluded from the study due to language and cognitive difficulties as well as 7 patients who were undergoing palliative care. 8 The Perme ICU mobility score is a tool developed to quickly assess patients' ability to mobilize while critically ill. 9 This system of measuring patients' mobility uses the ability to follow commands, functional strength, and endurance (measured in 2-min walk distance) to give patients a score from 0 to 32. The score is derived from the physical therapist's assessment of mental status, barriers to mobility, strength, in-bed mobility, ability to transfer, gait, and endurance.…”

“…Categorically, the subjects' ability to transfer from one position (eg, transfer from bed to chair) represented the biggest changes in the Perme score within this cohort. 8 One explanation for the improvement in mobility scores may be due to decreased work of breathing. Sutt et al 10 demonstrated that speaking valves helped decrease work of breathing, in part, due to observed increases in end-expiratory lung volume.…”

“…In addition, the Perme scores were assessed as totals and categories within the overall score were not evaluated for improvements within the categories. 8 For example, the authors may have found improved benefit within the specific Perme score categories, such as in-bed mobility versus transfers, or vice versa, had they analyzed these more-specific data.…”