Placement of a cuffed tracheostomy tube generally causes dysphagia, aphonia, and reduces the ability of the patient to taste and smell. Patients who are stable on mechanical ventilation, or those capable of maintaining spontaneous ventilation for a few hours, are candidates for a one-way speaking valve to restore voice communication. There are suitable valves for the ventilator-dependent and nonventilated patient.21-23 The one-way valve is placed on the tip of the tracheostomy tube with the cuff deflated; on inspiration, air enters the trachea through the valve, and on expiration, the valve closes and air exits through the upper airway, allowing normal glottic function. Speaking valves assist in the reestablishment of laryngeal reflex activity,
Anterior tracheal wall-
Anterior tracheal wall-
B Trachea phonation, and coughing without the need for finger occlusion. The inspiratory airway pressure that the patient requires to open the valve is relatively low (airflow resistance 2.6 cm H2O or less in all of the valves).24 The low resistance to open the valve should not add to increased effort to breathe, but it may do so, especially in patients with respiratory muscle weakness. The patient's breathing pattern and oxygen saturation should be monitored initially with the use of a speaking valve. Commonly, patients can clear secretions more easily, their sense of smell is stimulated, and their swallowing function improves. The valves are durable and easy to clean.
There are several one-way speaking valves designed to fit on standard tracheostomy tubes and stomal stents equipped with a 15 mm hub adapter. The most common one is the Passy-Muir tracheostomy speaking valve (Passy-Muir Inc., Irvine, CA) (Figure 38 - 7).22,24 The Passy-Muir (PMV) 2000 series is a low profile, lower resistance tracheostomy and ventilator speaking valve. The PMV 2000 frame is clear, designed to be less visible, whereas the PMV 2001 is bright purple to facilitate staff awareness. The PMV 2000 series valves are lightweight, smaller, open with less resistance, and can be used on or off the mechanical ventilator. These valves have the "Secure-It." This is an attachment that connects the PMV to the tracheostomy tie to prevent valve loss. The PMV 2000 series valves are closed position "no leak" valves offering benefits including improved swallowing, reduced aspiration, improved secretion management, reduced weaning, and decannulation time.25
The Shiley phonate speaking valve is available with or without an oxygen supplement port and cap (Mallinckrodt-Shiley). This valve is lightweight and the diaphragm has a hinged cap for easy access for cleaning. The Montgomery tracheostomy and cannula speaking valve is the only valve with a pressure release feature. This release feature reduces the risk of the valve popping off the 15 mm adapter of the tracheostomy tube during a forceful cough (Boston Medical Products, Inc.). The Olympic "Trach-Talk" (Olympic Medical) is a spring-loaded valve that clicks with opening and closing of the valve. The spring assists in reopening the valve on expiration. This speaking valve is T-shaped so it can be used for oxygen delivery and
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