Speaking Valve Not Always Best This letter is in response to “Patients Requiring Tracheostomy and Mechanical Ventilation: A Model for Interdisciplinary Decision-Making” (Jan. 20, 2009). It is good to see different disciplines bring their perspectives to patients who require tracheostomy and mechanical ventilation. Efficient evaluation that decreases time required for ventilator support and need for ... Inbox
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Speaking Valve Not Always Best
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Inbox   |   July 01, 2009
Speaking Valve Not Always Best
The ASHA Leader, July 2009, Vol. 14, 4. doi:10.1044/leader.IN2.14092009.4
The ASHA Leader, July 2009, Vol. 14, 4. doi:10.1044/leader.IN2.14092009.4
This letter is in response to “Patients Requiring Tracheostomy and Mechanical Ventilation: A Model for Interdisciplinary Decision-Making” (Jan. 20, 2009). It is good to see different disciplines bring their perspectives to patients who require tracheostomy and mechanical ventilation. Efficient evaluation that decreases time required for ventilator support and need for tracheostomy is critical.
As an advanced practice nurse with 30 years' experience in otolaryngology and as a speech-language pathologist with an interest in voice and swallowing, we must take issue with the practice of using speaking valves with surgical tracheostomy tubes with deflated cuffs. Because of the mechanics of airway dynamics and laminar flow, tracheostomy tubes are usually large to allow for the greatest internal diameter for ventilation. The large, redundant cuffs distribute cuff pressures on the trachea and prevent stenosis. Even with the cuffs deflated, the larger tubes and redundant cuffs take up a sizeable amount of the airway. For spontaneously breathing patients, it is more efficient to change to a smaller, cuffless tube. Consider the size of the airway and the amount of obstructed airspace in the trachea and then downsize to a cuffless tube to speed the decanulation process, which is the clinical goal. If this procedure is tolerated, the tracheostomy tube can be capped for normal, humidified airflow through the upper airway, also allowing speech.
Speaking valves are a tool, but airway dynamics cannot be overlooked. Because a useful tool is available that can enhance speech does not mean that it is the correct or most efficient one.
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July 2009
Volume 14, Issue 9