Tolerance of one-way in-line speaking valve trials in ventilator dependent children

Abdulrahman Althubaiti; Noah Worobetz; Justin Inacio; Jordan Lukens; Marike Mousset; Amanda Onwuka; Melanie Stevens; Leslie Justice; Edward G Shepherd; Gregory Wiet

doi:10.1016/j.ijporl.2022.111131

Tolerance of one-way in-line speaking valve trials in ventilator dependent children

Int J Pediatr Otorhinolaryngol. 2022 Jun:157:111131. doi: 10.1016/j.ijporl.2022.111131. Epub 2022 Apr 11.

Authors

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University, Columbus, OH, USA; Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
² Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
³ The Ohio State University, Columbus, OH, USA.
⁴ Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University, Columbus, OH, USA.
⁵ Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA.
⁶ Department of Speech Pathology, Nationwide Children's Hospital, Columbus, OH, USA.
⁷ The Ohio State University, Columbus, OH, USA; Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA.
⁸ Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State University, Columbus, OH, USA. Electronic address: Gregory.Wiet@nationwidechildrens.org.

PMID: 35429873
DOI: 10.1016/j.ijporl.2022.111131

Abstract

Background: Despite the advantages of tracheostomy placement in children requiring prolonged mechanical ventilation, vocalization and verbal communication remains limited in this population of children. The lack of these essential elements during a critical period of development can have a negative impact on overall development. In ventilator dependent children, in-line speaking valves (ISV) provide an opportunity for initiating speech and communication. The objective of this study is to examine patient characteristics and risk factors associated with tolerance and success of ISV trials performed with mechanically ventilated children.

Methods: A retrospective cohort study was conducted at a large, tertiary care children's hospital to evaluate the outcomes of ISV trials in ventilator-dependent children with tracheostomies, from 2009 to 2019. The primary endpoints were tolerance of the initial ISV assessment, and successful completion of a trial. We compared demographic and clinical characteristics among children that had a successful ISV trial to those that did not.

Results: Eighty-nine patients were included, 56 (62%) were male and 33 (38%) were female. Overall, 76 (85%) patients completed an ISV assessment and trial successfully during their hospitalization. The number of attempts before completing a successful trial varied with 41 (46%) patients succeeding on the first attempt. Children that underwent a tracheostomy for airway obstruction were more likely to fail.

Conclusions: Ventilator-dependent children with complex comorbidities demonstrate excellent tolerance of in-line speaking valves. Patients should be selected for ISV trials in a multidisciplinary setting. Airway obstruction as an indication for tracheostomy placement is a significant predictor of failure for ISV trials.

Keywords: In-line; PMV; Speaking; Tracheostomy; Valve.

MeSH terms

Airway Obstruction* / etiology
Child
Female
Humans
Male
Respiration, Artificial
Retrospective Studies
Tracheostomy* / adverse effects
Ventilator Weaning
Ventilators, Mechanical