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Tracheostomy tube manometry: evaluation of speaking valves, capping and need for downsizing
Douglas Clark Johnson1, Stacy Lynn Campbell, Judith Dawn Rabkin
1Spaulding Rehabilitation Hospital, Boston, MA 02114, USA. djohnson5@partners.org
The Clinical Respiratory Journal
|March 20, 2010
Summary
Manometry provides objective data to guide tracheostomy tube management, improving speech outcomes for patients. This method helps determine optimal speaking valve use and tube downsizing for better airway pressure management.
Area of Science:
- Pulmonology
- Speech-Language Pathology
- Medical Device Engineering
Background:
- Speaking readiness is a significant challenge for tracheostomized patients.
- Current evaluations for tracheostomy tube capping or speaking valve use are often subjective.
Purpose of the Study:
- To compare the performance of different speaking valves.
- To evaluate a novel care pathway for tracheostomy tube management, incorporating manometry.
Main Methods:
- Manometry and dyspnea were used to assess three speaking valves in 21 patients.
- A 100-patient cohort underwent evaluation using the developed care pathway, including pre- and post-tube change manometry.
Main Results:
- Speaking valves showed variations in inspiratory pressures; higher Borg scale scores correlated with high expiratory pressures.
- The care pathway led to recommendations for speech (speaking valve or capping) in 78% initially and 93% within 2 days.
- Tracheostomy tube downsizing was recommended for 94% of patients, significantly reducing airway pressures and increasing capping recommendations.
Conclusions:
- Tracheostomy tube manometry offers objective guidance for speaking valve use, capping, and tube selection.
- Early speech rehabilitation is feasible for the majority of tracheostomized patients.
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