Verbal communication with the Blom low profile and Passy-Muir one-way tracheotomy tube speaking valves

Highlights

• Both the Blom and Passy-Muir one-way tracheotomy tube speaking valves allowed for excellent functional verbal communication.

Abstract

Objective

To investigate physiologic parameters, voice production abilities, and functional verbal communication ratings of the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves.

Study design

Case series with planned data collection.

Setting

Large, urban, tertiary care teaching hospital.

Subjects and methods

Referred sample of 30 consecutively enrolled adults requiring a tracheotomy tube and tested with Blom and Passy-Muir valves. Physiologic parameters recorded were oxygen saturation, respiration rate, and heart rate. Voice production abilities included maximum voice intensity in relation to ambient room noise and maximum phonation duration of the vowel/a/. Functional verbal communication was determined from randomized and blinded listener ratings of counting 1–10, saying the days of the week, and reading aloud the sentence, “There is according to legend a boiling pot of gold at one end.”

Results

There were no significant differences (p > 0.05) between the Blom and Passy-Muir valves for the physiologic parameters of oxygen saturation, respiration rate, and heart rate; voice production abilities of both maximum intensity and duration of/a/; and functional verbal communication ratings. Both valves allowed for significantly greater maximum voice intensity over ambient room noise (p < 0.001).

Conclusions

The Blom low profile voice inner cannula and Passy-Muir one-way speaking valves exhibited equipoise regarding patient physiologic parameters, voice production abilities, and functional verbal communication ratings.

Learning outcomes: Readers will understand the importance of verbal communication for patients who require a tracheotomy tube; will be able to determine the differences between the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves; and will be confident in knowing that both the Blom and Passy-Muir one-way tracheotomy tube speaking valves are equivalent regarding physiological functioning and speech production abilities.

Introduction

Once a tracheotomy tube is required for airway maintenance normal verbal communication ability is lost with resultant concomitant negative impact on social interactions, care giver discussions, and overall-all quality-of-life (Levine et al., 1987, Parker, 1984, Safar and Grenvik, 1975, Sparker et al., 1987). The inability to speak increases psychological distress, depression, and malaise (Baskin et al., 2004, Hashmi et al., 2010). Alternatively, nonverbal communication techniques, e.g., lip reading, communication boards, writing or typing, and computerized augmentative communication systems, are imprecise, cumbersome, costly, and prone to breakage (Hashmi et al., 2010).

One-way tracheotomy tube speaking valves have been shown to be reliable and valuable devices to restore verbal communication (Leder, 1994). The one-way valve opens to allow inspiration through the tracheotomy tube but then closes blocking expiration via the tube and thereby diverting expired air up through the larynx, upper airway, and mouth for speech production. Criteria for use of a one-way tracheotomy tube speaking valve are adequate cognition and ability to tolerate either full cuff deflation or a cuff less tube (Passy, 1986). A one-way valve eliminates both the need for finger occlusion and intolerance of permanent capping due to upper airway obstruction. Voice intensity associated with a successful one-way speaking valve must be greater than ambient room noise to allow for audible and intelligible speech production (Leder, 1990, Leder and Traquina, 1989).

The Passy-Muir one-way valve attaches to the external 15 mm universal hub of any tracheotomy tube and uses a bias-closed valve, i.e., only opens during inspiration (Fig. 1A). Exhaled air is directly caudally between the tracheal wall and non-fenestrated tracheotomy tube. The Blom low profile one-way valve can only be used with the Blom fenestrated tracheotomy tube and is the inner cannula with a flap-valve at the distal tip just above the fenestration (Fig. 1B). Exhaled air is directed both up through the tracheotomy tube exiting via the fenestration and between the tracheal wall and tracheotomy tube.

The purpose of this study was to compare the new Blom low profile voice inner cannula and the established Passy-Muir (Passy, 1986) one-way speaking valves. It was hypothesized that there would be no differences in physiologic parameters, voice production abilities, and functional verbal communication ratings between the two valves.