Maintained expiratory airway pressure values as an indicator of tolerance of speaking valve in tracheostomized patients Introduction: Speaking valve (SV) is an unidirectional fl ow device installed over the tracheostomy tube allowing phonation. Tolerance to this device depends on the permeability of the upper airway (UA), which may be indirectly assessed by measuring UA maintained expiratory pressure (PEMant). Objective: To evaluate the usefulness of the maintained expiratory pressure as a clinical indicator of tolerance to the SV. Method: Twenty three tracheostomized patients (median age 22 months-old) were evaluated with an aneroid manometer during 15 minutes, recording PEMant, arterial oxygen saturation (SaO 2), heart rate, respiratory rate, accessory muscle use and wheezing as signs of respiratory distress Results: PEMant values less than 10 cmH 2 O are associated with tolerance of the SV and values over 20 cmH 2 O are associated with intolerance. Conclusion: Values under 10 cmH 2 O of PEMant can be used as an indicator of tolerance to VF.

Flow generator with double level pressure (BiPAP) through Tracheostomy Background: The Chilean Program of Noninvasive Home Ventilation started using flow generating equipment with differential pressure at 2 levels (BiPAP) through tracheostomies for prolonged mechanical ventilation (PMV). Objective: Describe the experience of this ventilatory support, reporting selection criteria, procedure and technological requirements. Method: Descriptive-transversal study that includes 20 patients treated at Hospital Josefina Martínez, other pediatric hospitals and at home, for 12 months since June 2006. The clinical features, ventilation support, technical characteristics, follow-up and complications were reported. Results: The mean age was 3.5 years-old (range 3 months-17 years). The duration of PMV ranged between 1 month to 5 years. Six patients (30%) are at home and 14 (70%) are hospitalized. In 14 patients (70%), the need of PMV was due to neuromuscular diseases. There was no mortality related to the use of Bipap through tracheostomy; only 4 patients had minor complications. Conclusions: This report suggests that the use of BiPAP through tracheostomy in patients with selection criteria is an applicable PVM method. However, comparative systematic trials are necessary to define costs, benefits and risks of this type of ventilation.

Nebulized 5% hypertonic saline decreases respiratory exacerbations in pediatric patients with tracheostomyNebulized hypertonic saline solution is useful in pediatric diseases such as bronchiolitis and cystic fibrosis. However its usefulness in pediatric patients with tracheostomy has not been studied. Our aim was to determine the usefulness of nebulized hypertonic solution 5% (SSH5%)