Question 27.3
a) What is the device depicted below?
b) List the contra-indications to its use
College Answer
a) What is the device depicted below?
Passy Muir speaking valve
b) List the contra-indications to its use
Unconscious / comatose patient
Inflated tracheostomy tube cuff
Severe upper airway obstruction that may prevent sufficient exhalation
Excessive secretions
Severe COPD with gas trapping
Foam filled cuff tracheostomy tube (eg Bivona)
Endotracheal tube
Discussion
Designed by Patricia Passy and David Muir, this device is more correctly named the Passy-Muir Speaking and Swallowing Valve. David was in fact a tracheostomy patient, and the valve is his idea. This device is discussed in greater detail in the The Passy-Muir Valve chapter.
The company guards its patents jealously, but there are some free educational materials to be found on their site.
I have compiled a list of contraindications which closely mirrors the college answers. Some of the college answers seem bizarre. Would anybody ever really try to attach one of these to an endotracheal tube? Is that really a contraindication?
- Inflated (or foam filled) tracheostomy cuff (you wont be able to exhale)
- Absence of a cuff leak with tracheostomy cuff deflated (you wont be able to exhale)
- Thick uncontrolled tracheal secretions (you will clog the valve)
- Thick uncontrolled oral secretions (you need to be able to swallow those, or they will get inhaled)
- Severe respiratory weakness (you will not be able to overcome the valve resistance to inspiration)
- Unconsciousness (You cant deflate the cuff in these people)
- Gas trapping with autoPEEP (the valve will increase PEEP)