Respiration and Ventilation Outcomes With Passy Muir Valve Use in Infants and Children Requiring Mechanical...

The study aimed to evaluate the clinical characteristics associated with successful Passy Muir Valve (PMV) use in children requiring mechanical ventilation via tracheostomy.

A retrospective study of children requiring mechanical ventilation via tracheostomy who completed PMV evaluations between 2021 and 2023 was conducted. Clinical characteristics of patients were compared based on success and failure of PMV tests. Group comparisons before and after cuff deflation and during PMV utilized the Wilcoxon signed-rank test. Wilcoxon rank sum and Fisher's exact tests were used to compare patients who passed and failed PMV.

Thirty-two children completed PMV evaluations with a success rate of 69%. After cuff deflation, there were no significant changes in median PEEP (p = 0.565), tidal volume (p = 0.118), oxygen saturation (SpO₂, p > 0.999), and end-tidal carbon dioxide (ETCO₂, p = 0.628). There was a small decrease in median PIP (p = 0.028). For patients who passed the PMV test, before and during PMV use, the median PEEP/transtracheal pressure remained unchanged, there was a decrease in tidal volume (p = 0.004), and a small decrease in PIP (p = 0.024) without significant changes in SpO₂ (p = 0.837), and ETCO₂ (p = 0.515). Patients on pressure-controlled ventilation who passed PMV tests demonstrated a median decrease of 35% in exhaled tidal volume after cuff deflation, while patients who failed demonstrated a 2% decrease.

The changes in PEEP, PIP, and tidal volume with tracheostomy cuff deflation and during PMV tests did not adversely impact oxygenation or ventilation in patients who passed the PMV test. Assessing airway patency via manometry could be implemented for all pediatric patients in our cohort rather than solely utilizing the decrease in exhaled tidal volume with cuff deflation. A systematic multidisciplinary protocol could identify patients who are eligible for PMV use.