2000 OPEN FORUM Abstracts
EVALUATION OF AIRWAY PRESSURE BY MANOMETRY IN TRACHEOSTOMIZED CHILDREN USING PASSY MUIR VALVE
C Moser MD, T Newton RRT, E Nussbaum MD. Department of Pediatrics, Miller Children's Hospital, Long Beach, CA
BACKGROUND: The use of the Passy Muir Speaking Valve (PMSV) has been shown to improve speech, help improve sense of smell, improve swallowing, reduce the risk of aspiration, facilitate secretion management, and expedite tracheal decannulation. Our hypothesis is that the use of the Passy Muir Valve may actually improve lung function and provide a CPAP effect in the airway, which can be measured. This may replace the need for home CPAP in some patients. METHODS AND MEASUREMENTS: We prospectively evaluated 39 patients, with an age range of 1 month to 18 years (median 36 months, SEM 10.22 months). All tracheostomy tubes were non-cuffed Shiley or Bivona. Five of the 39 patients were unable to use the Passy Muir Valve due to an inadequate air leak around the tracheostomy tube resulting in distress. A Bivona side port adapter was placed on the tracheostomy tube and a PMSV was placed on top of the side port adapter. Oxygen tubing was connected from the side port adapter to a Novametrix Pneumogard 1230A, (Novametrix, Wallingford, CT) a pressure monitoring device with a pressure wave form printout.
Results: The airway pressure (Paw) generated at rest in the patients who tolerated the PMSV, was less than 25cm H20. Patients who did not tolerate the PSMV, had Paw greater than 25cm H20 at rest. Four patients who did not tolerate the valve showed immediate stair stepping of pressures leading to popping off of the valve. In patients who tolerated the PMSV, Paw increased to the range of 15 to 80cm H20 with sigh breaths and >100cm H20 with coughs. However, their Paw returned to a baseline of less than 25cmH20 usually within a couple of breaths. In four of the patients who had documented bronchomalacia by bronchoscope and who required CPAP of 6 - 8cm_s H20 to maintain oxygen saturation in normal range. The use of PMSV replaced the need of a CPAP machine.
CONCLUSION: The Paw generated with the use of PMSV are measurable, and generally higher than physiologic. Paw < 25cm H20 at rest appears to be safe in the patients that we studied. The CPAP effect generated by the use of PMSV help eliminate the need of CPAP machine in some patients with bronchomalacia.