2012 OPEN FORUM Abstracts
EVALUATION OF AIRWAY PRESSURE AND TOLERANCE OF THE PASSY MUIR VALVE IN PEDIATRIC PATIENTS WITH TRACHEOSTOMY.
Carolyn McHendry1, Thomas J. Cahill1, Cynthia C. White1, R. Paul Boesch2; 1Cincinnati Childrens Hospital, Cincinnati, OH; 2Pulmonary Medicine, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH
Background: For pediatric patients with a tracheostomy, utilizing a Passy Muir Valve (PMV) may facilitate phonation, smell, taste, swallowing, secretion management, and improve cough. Two previous reports in the literature recommend monitoring airway pressure during use of a PMV to ensure an intact upper airway and prevent complications from high airway pressures(1,2). A pressure of < 10 cmH20 is recommended, but this may substantially limit the number of pediatric patients who are able to tolerate the PMV. In order to offer the benefits of using a PMV to more patients, we adopted an institutionally approved modification procedure to provide pressure relief by drilling up to two holes in the PMV for patients with pressures > 10 cmH20. The objective of this retrospective study is to identify how many of our pediatric patients were able to safely wear a PMV with and without the modification procedure. Methods: A retrospective chart review was performed for patients fitted with a PMV from November 2011 to May 2012 to assess airway pressure. Baseline pressure was recorded for all patients. If the modification was ordered, the pre and post pressures were recorded along with trach/type, size, airway diagnosis, age, number of holes drilled, and PMV tolerance. Data was recorded in an excel spreadsheet and is reported as mean and SD. Results: 25 patients were included in the study from our transitional care center, complex airway floor, and pulmonary clinic. Age range- 6 m to 27y/o, mean 5.46 (+/-5.8). Mean baseline pressure 19.2 (+/-13.6). 60% of the patients required a PMV modification. 24% required only one hole with mean pressure change 15.22 (+/-8.07). 36% required 2 holes with mean pressure change 9.2 (+/-33). Mean total pressure 7.9 (+/-2.07). One patient did not tolerate the PMV with 2 holes, but was able to tolerate with 2 holes after downsizing trach. Discussion: Implementation of a Procedural Guideline for monitoring and modification of PMV valves has standardized practice, increased patient safety by preventing high airway pressures, and allowed more patients to benefit from wearing a PMV. References: 1. Gereau SA, Navarrob GC, Cluterio B, Bassila M, Ruben RJ. Selection of pediatric patients for use of the Passy-Muir valve for speech production.1996;35:0-6. 2. Brigger MT, Hartnick CJ. Drilling speaking valves: a modification to improve vocalization in tracheostomy dependent children.The Laryngoscope 2009;119(1):176-179. Sponsored Research - None