Tracheostomy speaking valve modification in children: A standardized approach leads to widespread use
Tracheostomy speaking valve modification in children: A standardized approach leads to widespread use
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DOI：
10.1002/ppul.24209
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发表时间：
2019-04-01
影响因子：
3.1
通讯作者：
McNally, Paul
中科院分区：
文献类型：
--
作者：
Greene, Zelda M.;Davenport, Jim;McNally, Paul
背景气管切开术与声音、言语和进食/吞咽的负面影响有关。发声阀在这些方面具有有益效果，但通常禁忌用于因高经气管压（TTP）而出现气道问题的儿童。通过钻孔对阀门进行改造，以减少过度的TTP。我们假设，通过钻孔进行评估和瓣膜修改的标准化方法可以提高瓣膜耐受性并允许广泛的成功使用。MethodsFollow在我们中心制定了用于患者选择、瓣膜修改和瓣膜处方的标准化多学科方案，我们回顾性地收集了从2009年2月至2009年2月接受发音阀评估的所有儿童的临床记录中与临床适应症和病史相关的信息。2014年至2017年6月。我们设计了一份问卷，这是提供给父母的儿童接受修改和标准的阀门询问有关的声音，喂养，通信，和suction.ResultsData的45名儿童被收集。13例TTP正常，并给予标准瓣膜，32例TTP高，所有患者的瓣膜均经过改良，耐受性良好。17名儿童在安置时接受正压通气。调查答复率为83%。父母报告的高度满意度与修改的阀门和报告的声音，语音和喂养/吞咽方面的积极影响类似的报告为standard valves.ConclusionsSpeaking阀门可以成功和安全地修改儿童，提供阀门，以前被认为是不合适的许多患者。我们报告了这些改良瓣膜与标准瓣膜的积极父母经验。
BackgroundTracheostomy is associated with negative effects on voice, speech, and feeding/swallowing. Speaking valves have beneficial effects in these areas but are often contra-indicated in children with airway problems due to high transtracheal pressure (TTP). Valves are modified by drilling to reduce excessive TTP. We hypothesized that a standardized approach to assessment and valve modification by drilling improves valve tolerance and allows widespread successful use.MethodsFollowing development of a standardized multidisciplinary protocol for patient selection, valve modification and valve prescription at our center, we retrospectively collected information from clinical notes relating to clinical indication and medical history of all children undergoing speaking valve assessment from February 2014 to June 2017. We designed a questionnaire which was delivered to the parents of children receiving both modified and standard valves enquiring about voice, feeding, communication, and suctioning.ResultsData on 45 children were collected. Thirteen had normal TTP and were given standard valves and 32 had high TTP, all of whom had their valves modified resulting in good tolerance. 17 Children were on positive pressure ventilation at the time of placement. The survey response rate was 83%. Parents report a high degree of satisfaction with modified valves and report positive effects in terms of voice, speech, and feeding/swallowing similar to those reported for standard valves.ConclusionsSpeaking valves can be successfully and safely modified in children, providing valves to many patients previously deemed unsuitable. We report positive parental experiences of these modified valves in line with those reported with standard valves.