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

Sutt, Anna‐Liisa; Caruana, Lawrence R.; Dunster, Kimble; Cornwell, Petrea; Anstey, Chris

doi:10.1186/s13054-016-1249-x

Cited by 53 publications

(60 citation statements)

References 35 publications

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“…Data obtained from a previous study [120] underwent secondary analysis using EIT Data Analysis tool 6.1 (PulmoVista 500, Dräger Medical, Lűbeck, Germany) to assess EELI distribution and TVar into 4 ROIs. EITdiag™ was used to assess VSA and RVD globally and in 4 ROIs.…”

Section: Methodsmentioning

confidence: 99%

“…Data sets were obtained from twenty consecutive patients admitted to a cardiothoracic ICU in whom a SV (PMV007, Passy-Muir Inc, Irvine, California, US) was used in-line with mechanical ventilation and met the study inclusion criteria [120]. Two subgroups existed within the data set: (1) 10 patients receiving PSV using a PB840 (Puritan Bennett/Covidien, Carlsbad, California) ventilator, and (2) …”

Section: Participants and Proceduresmentioning

confidence: 99%

“…These patients are generally left without a voice for prolonged periods due to concerns that the required cuff deflation could lead to alveolar collapse and derecruitment of the lungs. A recent study reported improved EELI when using a SV in-line with mechanical ventilation [120]. Whilst increases in EELI may indicate alveolar recruitment, the analyses conducted to-date cannot exclude hyperinflation of some parts of the lung or in fact no clinically significant changes in lung volumes [54,121].…”

Section: Introductionmentioning

confidence: 96%

“…Together with previous methods of analysis such as EELI, EELI distribution and TVar there is the potential to obtain greater insights into how the previously observed increase in EELI during and post SV use [120] may impact lung recruitment and ventilation distribution.…”

Section: Introductionmentioning

confidence: 99%

“…The aim of this paper is to determine the ventilation re-distribution, if any, created by the increased EELI reported previously [120]. The secondary aim was to determine the efficacy of the novel EIT data analysis tool (EITdiag TM , Dräger Medical, Lűbeck, Germany)…”

Section: Introductionmentioning

confidence: 99%

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Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

Sutt¹

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Tracheostomised mechanically ventilated patients are often left unable to speak, which is frustrating for patients and the staff caring for them. Having no voice causes major distress and feelings of helplessness for patients. Voicelessness frequently leads to reduced information exchange between the patient and healthcare team, frequently to the detriment of patient care. An in-line speaking valve (SV) is a one-way valve that may be used in the mechanical ventilation circuit to enable verbal communication in tracheostomised patients.Limited data exist regarding the effect of SVs on respiratory mechanics. Deflation of the tracheostomy cuff is required for placement of the SV, effectively causing a "leak" in the As an experienced speech pathologist, I believe concerns over SV use to date have little evidence. The main objective, and first aim of this thesis was to investigate the effect of SV use on respiratory mechanics to determine whether SVs should be used in-line with mechanical ventilation of tracheostomised patients. The second aim was to assess the effect of introducing SVs into a cardio-thoracic ICU on patient tracheostomy specific outcomes. The third aim was to further clarify the effect of SVs on success with healthrelated communication for ICU patients. To achieve these aims, 5 studies were conducted, resulting in 5 manuscripts.For the first aim, 20 tracheostomised ICU patients using a SV that met the inclusion criteria were recruited to the study from November 2013-December 2014. Electrical Impedance iii Tomography (EIT) was used to assess the patients' end-expiratory lung impedance (EELI) and ventilation distribution continuously over 60 minutes (before, during and after SV use). For the third aim, 25 patients and 52 nursing staff were asked to fill out a custom-made questionnaire on success with health communication, firstly when the patients were voiceless, and, secondly, when they were using a SV. Chapter 7 highlights individual differences and some disparity between patient and nursing ratings of communication success. Overall, however, following SV use both the patients and nursing staff reported a significant improvement in success with health communication. Additional variables included oxygenation (SpOIn conclusion, the findings of this thesis addressed the research aims, and provide new knowledge through use of an innovative approach to assessing lung mechanics. Having iv already resulted in real clinical changes in our centre, the results indicate the potential for optimising communication, using SVs in tracheostomised cardiothoracic ICU patients undergoing weaning from mechanical ventilation.v

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Section: Methodsmentioning

confidence: 99%

Section: Participants and Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

Sutt¹

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Failure of standard tracheostomy decannulation criteria to detect suprastomal pathology

Thomas

Talbot

Drewery

2020

Anaesthesia Reports

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Meeting established criteria for tracheostomy decannulation should improve success, although there will be a small proportion of patients with a tracheostomy who fail decannulation. Failure rates depend on patient characteristics and disparity between institutional practices and expert opinion. However, there are no widely accepted published failure rates, or agreement on the time-point at which failure is assessed. We present a patient who had evidence of readiness for decannulation, but had immediate failure due to extrinsic tracheal compression, which proved difficult to diagnose and required surgery to resolve. Capping the tracheostomy before decannulation may or may not have given rise to suspicion of potential failure and this practice requires further evaluation as it is not without risk. For subglottic, but suprastomal lesions, nasendoscopy is not of value. It is important to decannulate patients in a safe environment, preferably early in the day to allow post decannulation observations and interventions should they become necessary, and with the close involvement of the multi-professional team. This report illustrates the failure of our standard Tracheostomy decannulation criteria, and direct upper airway view to identify suprastomal tracheal pathology, and we discuss the potential for additional criteria which may have identified the issue before decannulation attempts.

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Promoting Independence

Dawson¹

2020

Passport to Successful ICU Discharge

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

Cited by 53 publications

References 35 publications

Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

Failure of standard tracheostomy decannulation criteria to detect suprastomal pathology

Promoting Independence

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