Tracheostomy tube manometry: evaluation of speaking valves, capping and need for downsizing

Johnson, Douglas C.; Campbell, Stacy Lynn; Rabkin, Judith Dawn

doi:10.1111/j.1752-699x.2008.00100.x

Cited by 32 publications

(36 citation statements)

References 7 publications

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“…If the tracheal pressure is Ͼ 5 cm H 2 O during passive exhalation (without speech) with the speaking valve in place, this may indicate excessive expiratory resistance. 2,39 If the tracheal pressure is high, consideration should be given to downsizing the tube. The upper airway should also be assessed for the presence of obstruction (eg, tumor, stenosis, granulation tissue, secretions).…”

Section: Spontaneously Breathing Patientsmentioning

confidence: 99%

Tracheostomy TubesDiscussion

Hess

Altobelli

2014

Respir Care

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Section: Spontaneously Breathing Patientsmentioning

confidence: 99%

Tracheostomy TubesDiscussion

Hess

Altobelli

2014

Respir Care

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“…Assessment by speech pathology revealed limited airflow via the upper airway, and bedside transtracheal manometry demonstrated elevated pressures (30 cm H 2 0) well beyond the recommended range of transtracheal pressures considered optimal for valve tolerance. 12 Supervised PMSV trials resulted in strained voicing, tachypnea, breath stacking, and respiratory distress.…”

Section: Case Presentationmentioning

confidence: 99%

“…12 Typically, this is addressed with downsizing; however, additional upper airway resistance from postoperative edema, airway stenosis, or flap bulk can also contribute. Furthermore, a large proportion of this population has underlying pulmonary disease that limits smaller diameter tracheostomy tolerance.…”

mentioning

confidence: 99%

Technique to Improve Tracheostomy Speaking Valve Tolerance after Head and Neck Free Flap Reconstruction

Stranix

Danziger

Dumbrava

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Summary:Increased upper airway resistance from postoperative changes after major head and neck surgery may cause elevated transtracheal pressures and result in tracheostomy speaking valve intolerance. This may be particularly true among patients with baseline pulmonary disease. We describe a patient recovering from oral cancer resection and flap reconstruction who demonstrated prolonged ventilator dependence and tracheostomy speaking valve intolerance with abnormal tracheal manometry. We attempted to improve speaking valve tolerance through the adaptation of a valve modification intended to reduce transtracheal pressures. Drilling holes into the 1-way speaking valve allowed for excess air egress and resulted in normalization of transtracheal pressures with improved speaking valve tolerance. This 1-way speaking valve modification may serve as a simple method to allow for earlier restoration of voicing and potentially reduce the number of ventilator- dependent days in this patient population.

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“…Une alternative au test d'occlusion est la manométrie sur canule de trachéotomie [25]. Il s'agit d'une technique objective qui peut être intégrée au protocole de sevrage de la trachéotomie.…”

Section: éValuation Des Voies Aériennes Supérieuresunclassified

Management of decanulation in the tracheostomized patient

Brunet¹,

Dufour-Trivini

Sauneuf³

et al. 2015

Réanimation

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La trachéotomie est un geste fréquemment pratiqué en réanimation dans des indications diverses en relais de l'intubation. Malgré les nombreux avantages qu'on lui reconnait, la trachéotomie est source de complications. Réévaluer son intérêt et procéder à la décanulation dès que possible est donc un enjeu majeur. L'intervention d'équipes spécialisées multidisciplinaires, l'utilisation de protocoles standardisés, améliorent le suivi et favorisent la décanulation plus précoce. Celle-ci est possible si plusieurs conditions sont réunies : la pathologie ayant motivé la trachéotomie doit être résolue, le statut neurologique compatible, le patient stable cliniquement, les voies aériennes libres, le patient capable d'expectorer et le risque d'inhalation écarté. L'évaluation de ces différentes éta-pes passe par la compréhension et l'évaluation de fonctions telles que la toux, la déglutition et la parole. Par ailleurs, en cas d'impossibilité de sevrage de la trachéotomie, il est possible d'améliorer notablement le confort des patients trachéo-tomisés en leur donnant accès pendant cette période à la parole et l'alimentation orale notamment. Ceci doit être un enjeu pour tout praticien prenant en charge des patients trachéotomisés.Abstract Tracheostomy is a common intensive care procedure performed for a variety of reasons in intubated patients who require prolonged airway access. Despite its many recognized advantages, tracheostomy is associated with complications. A reappraisal of the usefulness of this procedure and performance of decannulation as early as possible are therefore key goals. Involvement of specialized multidisciplinary teams and use of standardized protocols improve patient's follow-up and chances of earlier decannulation. Candidates for decannulation should meet several criteria including resolution of the condition that required tracheostomy, neurological status consistent with independent breathing, stable clinical status, patent airways, ability to expectorate, and no risk of inhalation. These criteria should be evaluated by assessing coughing, swallowing, and speech functions. If weaning off the tracheostomy is not feasible, patient comfort can be improved by allowing speech and oral feeding, particularly when cannula is in place. This concern should be the main goal of all physicians providing care to tracheostomized patients.

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Tracheostomy tube manometry: evaluation of speaking valves, capping and need for downsizing

Abstract: Tracheostomy tube manometry is very helpful in objectively guiding recommendations for speaking valve use, capping, and changing tracheostomy tubes. Speech is an early recommendation for most patients.

Cited by 32 publications

References 7 publications

Tracheostomy TubesDiscussion

Tracheostomy TubesDiscussion

Technique to Improve Tracheostomy Speaking Valve Tolerance after Head and Neck Free Flap Reconstruction

Management of decanulation in the tracheostomized patient

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