Clinical Publications of Interest 2025-03
Valves for the Voiceless: Time to Speaking Valve Use in Posttracheostomy Patients After Multidisciplinary Initiative
The inability to speak has been ranked as the most distressing moment of the ICU stay. Speaking valves (SV) are an option for tracheostomy patients to interact with health care professionals (HCPs). Despite their importance, there are still barriers to SV implementation. The study aimed to evaluate the impact of a multidisciplinary team and new protocols on the use of SVs and the time to initiate SV trials in posttracheostomy patients. The authors conducted a retrospective case series which included 421 patients who underwent tracheostomy between 2017 and 2023. The study compared the calendar days between meeting SV eligibility criteria and initial SV trial before and after the dissemination of new protocols from a multidisciplinary tracheostomy care initiative in 2019. After protocol dissemination, eligible patients with an SV trial increased from 75% to 95%, and the percentage of patients who tolerated the SV on their first attempt increased from 60% to 75%. The protocol implementation was associated with an overall 80% decrease in time to SV placement. The dissemination of the multidisciplinary protocols significantly increased SV use and decreased time to SV trials, improving patient communication and care. Additional quality improvement efforts at the institutional level could help address any remaining challenges to SV implementation.
Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: A systematic review
The article reviews the use of one-way speaking valves in tracheostomized patients. These valves, first engineered in 1985, allow patients to communicate and may offer additional physiological benefits. The review evaluates evidence across various physiological domains such as vital signs, aspiration, olfaction, ventilation, tracheostomy weaning, length of stay, and quality of life. A literature search conducted in September 2017 identified 16 studies comparing the use of speaking valves to no valves across different parameters. Results showed a significant reduction in aspiration (OR 0.122; 95% CI, 0.031-0.479; p = 0.003) and improvements in olfaction accuracy and secretion management. While there were no significant differences in heart rate, respiratory rate, oxygen saturations, or arterial blood gases, there was a decrease in end-tidal CO2 and an increase in end-expiratory lung impedance, indicating better ventilation. The review found no significant impact on the duration of mechanical ventilation or length of stay, but some studies suggested a median reduction of one day in weaning. Quality of life measures improved, though not statistically significant. The review concludes that speaking valves offer additional benefits, particularly in reducing aspiration and enhancing ventilation, warranting further studies to explore clinical outcomes and healthcare cost reductions.
Clinical feasibility study of protrach dualcare a new speaking valve with heat and moisture exchanger for tracheotomized patients
The study aimed to evaluate the clinical feasibility of the ProTrach DualCare device. A non-randomized, prospective single-center feasibility study was conducted with 16 adult tracheotomized patients. Participants tested DualCare for two weeks, followed by an optional long-term evaluation. Various scales and questionnaires were used to assess speaking, pulmonary function, and patient preference. The results showed that the device was well-tolerated, with significant improvements in speech naturalness (p = 0.020) and reduced speaking noise (p = 0.020). Breathing in HME mode was significantly easier (p = 0.006) compared to the pre-study device, and participants reported less shortness of breath while climbing stairs (p = 0.011). Additionally, there was less discomfort breathing dry air (p = 0.031) and fewer dry coughs during the night (p = 0.039). Overall, 11 out of 16 participants (69%) preferred DualCare over their standard device. In conclusion, the ProTrach DualCare was preferred by the majority of participants and considered clinically feasible. The authors concluded it has the potential to improve the quality of life for tracheotomized patients by combining the benefits of hands-free speech and an HME.
The Use of Speaking Valves in Children With Tracheostomy Tubes
One-way speaking valves help children with tracheostomies vocalize by redirecting airflow through the vocal folds, showing promising results in improving communication and managing secretions. However, there is a lack of comprehensive evidence on the use of speaking valves in pediatric patients. The aim of the scoping review was to synthesize and summarize existing literature to identify knowledge gaps and inform future research and clinical decision-making. Using the Arksey and O’Malley 5-step methodological framework, the authors searched multiple databases, including OVID MEDLINE, EMBASE, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar, for articles published between 1946 and 2016. The search yielded 524 articles, of which 12 met the inclusion criteria after screening and full-text review. The results showed that the sample sizes of the included studies ranged from 2 to 64 children, with most studies conducted in the United States. The evidence levels varied, with six studies categorized as level 5, four as level 4, and two as level 3. Level 5 evidence refers to expert opinion without explicit critical appraisal, level 4 includes case series and poor-quality cohort and case-control studies, and level 3 consists of well-designed cohort or case-control studies. The benefits of speaking valve use included improved communication, secretion management, and ease of breathing, although the evidence was limited and inconsistent. In conclusion, the current evidence on the use of speaking valves in children with tracheostomy tubes is inadequate, highlighting the need for well-designed studies to better inform clinical practice. Further research is essential to address the gaps in knowledge and improve outcomes for pediatric patients.
Standard versus Accelerated Speaking Valve Placement after Percutaneous Tracheostomy: A Randomized Controlled Feasibility Study
In the United States, speaking valve placement is often deferred until 48 hours after percutaneous tracheostomy, while in Europe and Australia, it is introduced within four hours. Early placement may expedite speech rehabilitation, improving communication and quality of life, but poses risks requiring further assessment. The randomized controlled trial investigates the feasibility, risks, and benefits of early (≤ 24 hours) versus standard (≥ 48 hours) timing for one-way speaking valve placement after percutaneous tracheostomy. Twenty awake patients were randomized into two groups: accelerated and standard timing for speaking valve placement. Outcomes measured included patient recruitment, adherence to protocol, speech and swallowing effectiveness, and clinical outcomes such as safety events and decannulation. The results showed that 20 out of 36 eligible patients were randomized. The median time to valve placement was 22 hours for the accelerated group versus 45.5 hours for the standard group. No aspiration, hypoxemia, or other safety events occurred. Sentence intelligibility test (SIT) scores did not differ between groups but correlated with patient perception of quality of life. The accelerated group tolerated longer speaking valve trials (65 vs. 15 minutes). Additionally, 7 patients in the accelerated group were decannulated before discharge compared to 1 patient in the standard group. In conclusion, early speaking valve placement within 24 hours is feasible and safe. A larger trial is recommended to further evaluate clinical outcomes and safety.
Effects of cuff deflation and one-way tracheostomy speaking valve placement on swallow physiology
Previous research has suggested an association between tracheostomy tubes and increased risk of aspiration, but the effects of cuff deflation and one-way valve (OWV) placement on specific aspects of swallowing physiology remain unclear. The aim of this systematic review was to determine the incidence of aspiration and physiologic changes in swallowing under three conditions: cuff inflated, cuff deflated, and OWV placement. Twenty-two non-ventilator-dependent patients with tracheostomy tubes were recruited, including fourteen with cuffed tracheostomy tubes and four with cuffless tubes. Participants completed videofluoroscopic swallow studies (VFSS) under the three conditions. Swallows were analyzed using an 8-point penetration–aspiration scale, swallow duration measures, hyolaryngeal elevation, anterior excursion, and oropharyngeal residue. The results showed that OWV placement significantly reduced penetration–aspiration scores for liquid bolus compared to cuff-inflated and cuff-deflated conditions. Pharyngeal transit duration and duration of hyoid maximum anterior excursion were longer for the cuff-deflated condition, while the duration of cricopharyngeal opening was shorter. Maximum hyoid anterior movement was greater for the cuff-deflated condition. However, OWV placement increased oral, posterior pharyngeal wall, and cricopharyngeal residue compared to the cuff-inflated condition. These findings suggest that OWV placement may benefit tracheostomized patients by reducing aspiration of thin liquids, thereby improving communication and quality of life. Further research is essential to assess the effects of OWV placement on pharyngeal and laryngeal sensitivity, subglottal pressure, and aspiration of thicker consistencies to better inform clinical practice.
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Clinical Publications of Interest summaries of journal articles are not exhaustive. For full content, please see the actual publication.
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