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

Sutt, Anna-Liisa, Caruana, Lawrence R., Dunster, Kimble R., Cornwell, Petrea L., Anstey, Chris M. and Fraser, John F. (2016) Speaking valves in tracheostomised ICU patients weaning off mechanical ventilation - do they facilitate lung recruitment?. Critical Care, 20 . doi:10.1186/s13054-016-1249-x


Author Sutt, Anna-Liisa
Caruana, Lawrence R.
Dunster, Kimble R.
Cornwell, Petrea L.
Anstey, Chris M.
Fraser, John F.
Title Speaking valves in tracheostomised ICU patients weaning off mechanical ventilation - do they facilitate lung recruitment?
Journal name Critical Care   Check publisher's open access policy
ISSN 1466-609X
1364-8535
Publication date 2016-04-01
Year available 2016
Sub-type Article (original research)
DOI 10.1186/s13054-016-1249-x
Open Access Status DOI
Volume 20
Total pages 9
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2017
Language eng
Formatted abstract
Background: Patients who require positive pressure ventilation through a tracheostomy are unable to phonate due to the inflated tracheostomy cuff. Whilst a speaking valve (SV) can be used on a tracheostomy tube, its use in ventilated ICU patients has been inhibited by concerns regarding potential deleterious effects to recovering lungs. The objective of this study was to assess end expiratory lung impedance (EELI) and standard bedside respiratory parameters before, during and after SV use in tracheostomised patients weaning from mechanical ventilation.

Methods: A prospective observational study was conducted in a cardio-thoracic adult ICU. 20 consecutive tracheostomised patients weaning from mechanical ventilation and using a SV were recruited. Electrical Impedance Tomography (EIT) was used to monitor patients' EELI. Changes in lung impedance and standard bedside respiratory data were analysed pre, during and post SV use.

Results: Use of in-line SVs resulted in significant increase of EELI. This effect grew and was maintained for at least 15 minutes after removal of the SV (p < 0.001). EtCO2 showed a significant drop during SV use (p = 0.01) whilst SpO2 remained unchanged. Respiratory rate (RR (breaths per minute)) decreased whilst the SV was in situ (p <0.001), and heart rate (HR (beats per minute)) was unchanged. All results were similar regardless of the patients' respiratory requirements at time of recruitment.

Conclusions: In this cohort of critically ill ventilated patients, SVs did not cause derecruitment of the lungs when used in the ventilator weaning period. Deflating the tracheostomy cuff and restoring the airflow via the upper airway with a one-way valve may facilitate lung recruitment during and after SV use, as indicated by increased EELI.

Trial registration: Anna-Liisa Sutt, Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN: ACTRN12615000589583. 4/6/2015.
Keyword Communication
FRC
Lung recruitment
Mechanical ventilation
Speaking valve
Tracheostomy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
Admin Only - School of Medicine
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 0 times in Thomson Reuters Web of Science Article
Scopus Citation Count Cited 0 times in Scopus Article
Google Scholar Search Google Scholar
Created: Tue, 19 Apr 2016, 00:26:11 EST by System User on behalf of Learning and Research Services (UQ Library)