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Crit Care. 2016 Apr 1;20:91. doi: 10.1186/s13054-016-1249-x.

Speaking valves in tracheostomised ICU patients weaning off mechanical ventilation--do they facilitate lung recruitment?

Author information

1
Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia. anna-liisa.sutt@health.qld.gov.au.
2
School of Medicine, University of Queensland, Brisbane, Australia. anna-liisa.sutt@health.qld.gov.au.
3
Speech Pathology Department, The Prince Charles Hospital, Brisbane, Australia. anna-liisa.sutt@health.qld.gov.au.
4
Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
5
Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
6
Science & Engineering Faculty, Queensland University of Technology, Brisbane, Australia.
7
Allied Health Collaborative, Metro North HHS, Brisbane, Australia.
8
School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
9
School of Medicine, University of Queensland, Brisbane, Australia.
10
Critical Care Research Group, Sunshine Coast University Hospital, Brisbane, Australia.

Abstract

BACKGROUND:

Patients who require positive pressure ventilation through a tracheostomy are unable to phonate due to the inflated tracheostomy cuff. Whilst a speaking valve (SV) can be used on a tracheostomy tube, its use in ventilated ICU patients has been inhibited by concerns regarding potential deleterious effects to recovering lungs. The objective of this study was to assess end expiratory lung impedance (EELI) and standard bedside respiratory parameters before, during and after SV use in tracheostomised patients weaning from mechanical ventilation.

METHODS:

A prospective observational study was conducted in a cardio-thoracic adult ICU. 20 consecutive tracheostomised patients weaning from mechanical ventilation and using a SV were recruited. Electrical Impedance Tomography (EIT) was used to monitor patients' EELI. Changes in lung impedance and standard bedside respiratory data were analysed pre, during and post SV use.

RESULTS:

Use of in-line SVs resulted in significant increase of EELI. This effect grew and was maintained for at least 15 minutes after removal of the SV (p < 0.001). EtCO2 showed a significant drop during SV use (p = 0.01) whilst SpO2 remained unchanged. Respiratory rate (RR (breaths per minute)) decreased whilst the SV was in situ (p <0.001), and heart rate (HR (beats per minute)) was unchanged. All results were similar regardless of the patients' respiratory requirements at time of recruitment.

CONCLUSIONS:

In this cohort of critically ill ventilated patients, SVs did not cause derecruitment of the lungs when used in the ventilator weaning period. Deflating the tracheostomy cuff and restoring the airflow via the upper airway with a one-way valve may facilitate lung recruitment during and after SV use, as indicated by increased EELI.

TRIAL REGISTRATION:

Anna-Liisa Sutt, Australian New Zealand Clinical Trials Registry (ANZCTR).

ACTRN:

ACTRN12615000589583. 4/6/2015.

KEYWORDS:

Communication; FRC; Lung recruitment; Mechanical ventilation; Speaking valve; Tracheostomy

PMID:
27038617
PMCID:
PMC4818462
DOI:
10.1186/s13054-016-1249-x
[Indexed for MEDLINE]
Free PMC Article

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