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

Abstract

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.

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

“…On the one hand, this procedure helps patients to practice breathing through the upper airway. On the other hand, the restoration of the physiological air flow is likely to result in a restitution of the pharyngeal and laryngeal sensitivity with consecutively improved secretion management [ 135 ]. In a proof-of-principle study recruiting 20 tracheotomized stroke patients, Ledl and Ullrich showed that while capping of the tracheal cannula did not induce any changes in swallowing mechanics, swallowing safety improved resulting in lower Penetration-Aspiration-Scale scores [ 136 ].…”

The safety and efficacy of prolonged use of one-way speaking valves

“…In previous studies, the use of oneway speaking valves showed improvements in ventilation (through changes in end-expiratory lung volumes) and a reduction in RR as a secondary result of improved ventilation. 15 Previous studies 8,13,32 have also demonstrated that the use of a one-way speaking valve provides additional PEEP, which correlates with improvements in ventilation. The recruitment of additional alveoli (that occurs with increased PEEP) provides an increased surface area for oxygen diffusion to occur, thereby improving oxygenation.…”

“…7,8 Others have reported that one-way speaking valves also improve olfaction, 9e11 secretion management, 9,12 ventilation, 8,13 and quality of life. 14 In a recent systematic review 15 the evidence for using one-way speaking valves, across a number of physiological domains including vital signs, aspiration, olfaction, ventilation and tracheostomy weaning, length of stay, and quality of life was evaluated. Whilst the evidence was not strong to support the additional physiological benefits, all studies favoured the use of a one-way speaking valve (compared with no speaking valve) or reported improvements that were not statistically significant.…”

Manejo fonoaudiológico do paciente traqueostomizado no contexto da Covid-19: uma revisão do conhecimento atual

“…A comunicação no paciente traqueostomizado foi citada em três estudos 2,4,7 . Uma recente revisão sistemática com meta-análise reforça os benefícios no uso da válvula de fala, incluindo melhora no olfato, gerenciamento de secreção, ventilação e qualidade de vida, além de redução de aspiração 15 . Por outro lado, ainda há controvérsias sobre o momento adequado para o uso da válvula de fala em pacientes com COVID-19.…”