Ventilation distribution and lung recruitment with speaking valve use in tracheostomised patient weaning from mechanical ventilation in intensive care

Sutt, Anna‐Liisa; Anstey, Chris; Caruana, Lawrence R.; Cornwell, Petrea

doi:10.1016/j.jcrc.2017.04.001

Cited by 23 publications

(30 citation statements)

References 24 publications

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“…Resting ventilation was investigated in two studies [24,27] using measurements of end-expiratory lung impedance (EELI) to indicate changes in ventilation. EELI was measured by means of electrical impedance tomography (EIT), with an increase in EELI indicating an increase, or recruitment of alveolar units.…”

Section: Ventilationmentioning

confidence: 99%

“…In the first study [24], the results demonstrated significant increases in EELI, of up to 120% from baseline, during 30 minutes of quiet breathing, while using a speaking valve. The second study [27], used a data analysis tool (EIT Data Analysis 6.1) to investigate ventilation distribution. This study demonstrated a uniform increase in ventilation across all lung segments, indicating that hyperinflation was not occurring.…”

Section: Ventilationmentioning

confidence: 99%

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Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: A systematic review

2019

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Background: The one-way speaking valve was first engineered in 1985 to allow patients with tracheostomy tubes to communicate. The research has indicated alternative physiological benefits of using a speaking valve, however this literature has not yet been evaluated. The purpose of this systematic review is to evaluate the evidence for the one-way speaking valve in relation to a range of physiological and clinical domains including vital signs, aspiration, olfaction, ventilation and tracheostomy weaning, hospital length of stay, and quality of life. Methods: A literature search was conducted in September 2017. Studies were eligible if they compared the use of a one-way speaking valve to no speaking valve in tracheostomised patients, across various physiological or clinical parameters. Results: Sixteen eligible studies were included in this review. A meta-analysis random-effect model (I 2 =71.96, p=0.006) found reduced instances of aspiration when a speaking valve was in situ compared to no speaking valve in situ (OR 0.122; 95% confidence interval, 0.031-0.479; P= 0.003). Statistically significant results were also found for the use of a one-way speaking valve in terms of olfaction, secretion management and ventilation. Conclusion: There is emerging evidence for the additional benefits of using one-way speaking valves in patients with tracheostomy tubes. Further studies are required to investigate these other promising utilities of the speaking valve and the subsequent effects on reducing healthcare costs and improving patient outcomes.

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Section: Ventilationmentioning

confidence: 99%

Section: Ventilationmentioning

confidence: 99%

Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: A systematic review

2019

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“…Four of these chapters include published [107,108,120], accepted or submitted manuscripts [137,179] in peer-reviewed journals. Manuscripts have been included in pre-publication format and numbering of tables, graphs and figures modified to align with the rest of the thesis.…”

Section: Discussionmentioning

confidence: 99%

“…To address the three aims of the thesis, 5 hypotheses were generated and five studies SV use in the cardio-thoracic ICU population [137].…”

Section: Discussionmentioning

confidence: 99%

“…Whilst recruiting patients to a previously reported study by our group [120,137], one patient in whom no past medical history of respiratory disease had been reported suffered a significant drop in oxygenation when a SV was attached to his TT in-line with high-flow oxygen therapy. This could not be rectified even when correcting the airflow (L/min) and Nothing in the medical history and blood gas analysis excluded the patient from assessment and use of SV.…”

Section: Rationalementioning

confidence: 99%

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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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What’s new in reducing the impact of tracheostomy on communication and swallowing in the ICU

2023

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Ventilation distribution and lung recruitment with speaking valve use in tracheostomised patient weaning from mechanical ventilation in intensive care

Cited by 23 publications

References 24 publications

Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: A systematic review

Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: A systematic review

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

What’s new in reducing the impact of tracheostomy on communication and swallowing in the ICU

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