The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


John S. Emberger, Joel M. Brown II; Respiratory Care, Christiana Care Health System, Newark, DE

BACKGROUND: A challenge for tracheostomy patients is the inability to speak. Today there are several commercially available speaking valves and devices that are designed to alleviate this challenge. A common issue with speaking devices is that they can cause increased inspiratory and expiratory airway resistance. It has been established that expiratory resistance > 5 cm H20/L/s can cause difficulty with passive exhalation, leading to air trapping* and that typical inspiratory resistance is ~ 2.5 cmH2O/L/s*. The Blom Tracheostomy Tube System (Blom) is a product that consists of a standard inner cannula and a Low Profile Valve (LPV) speech cannula. LPV speech cannula is novel soft flexible inner cannual with one way valve that allows inspiration through the tube lumen and exhalation through the fenestration while the cuff is inflated. We wanted to examine the resistance to inspiratory and expiratory flow of the Blom Tracheostomy Tube System. METHODS: A calibrated oxygen flow meter was connected to a high pressure oxygen source with flow set to 0.5 L/s while monitoring back pressure to calculate resistance. We examined resistance to flow in both inspiratory and expiratory directions of each of the 2 separate inner cannulas. The Blom tracheostomy tube system was adapted to the ASL 5000 with a simulated adult breathing a rate of 18 with tidal volume of 300ml. Graphic of the airway pressure was examined for differences between the standard cannula and the LPV speech cannula. RESULTS: The Blom standard inner cannula had a resistance of 3 cmH2O/L/s for both inspiratory and expiratory phase. The Blom LPV speech cannula had a resistance of 12 cmH2O/L/s for both inspiratory and expiratory phases. See graphic for airway pressure tracings showing a swing of ~2 cmH20 and ~6 cmH2O for the standard and LPV cannula respectively in a simulated patient. CONCLUSION: The Blom Tracheostomy Tube System with the LPV speech cannula is an innovative design for speech with cuff up and no speaking valve. Clinicians should make sure that the patient population choosen for this device will tolerate the higher than average resistance* of this speaking device. Patients will need adequate expiratory muscle strength to overcome the resistance that it produces. Further studies will need to be done to determine that best patient population that would be suited for this device. *Hess, D. Facilitating Speech in the Patient with a Tracheostomy. Resp Care 2005:50(4):519-525 Sponsored Research - None Airway Graphic of the Blom Tracheostomy system Standard Cannula and LPV speech cannula.