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Secretion Management

Misconception: “We can’t deflate the cuff because the patient will aspirate”

Clinicians often believe that cuff deflation and speaking valve use should be delayed if the patient has “a lot” of secretions. However, evidence indicates that:

  • Secretions are a natural response to the presence of the tracheostomy tube in the airway.

  • With the cuff inflated, excess secretions are expected as a result of poor pharyngeal and laryngeal sensation, and reduced subglottic pressure and cough strength. The longer the tracheostomy cuff is kept inflated, the more secretions pool above the cuff and in the pharynx. Swallowing of secretions occurs less frequently.1

  • The type, amount and manageability of secretions varies from patient to patient. It is only when secretions are thick, copious and cannot be mobilized in the airway that breathing with the Passy Muir Valve may be difficult for patients. This can can be addressed with aggressive pulmonary hygiene, including increased humidity therapy, mucolytics, and postural drainage to help loosen and mobilize thick secretions.

Clinical Research Demonstrates that Deflating the Cuff and Early use of the Passy Muir® Valve Improves Secretion Management:

  • Passy Muir Valve placement restores laryngeal and pharyngeal sensation by directing airflow back through the upper airway. Improved sensation enables the opening and closure laryngeal reflexes to return to normal, which restores the protective cough reflex, and contributes to a safe swallow.2

  • The Passy Muir Valve improves the ability to clear material that enters the airway.3-5 The Valve facilitates expiratory volume through the upper airway after swallowing, which helps to expel material that may be misdirected to the trachea during swallowing.4 Occlusion of the tracheostomy tube permits an effective cough, throat clear, and other techniques requiring subglottic air pressure.5

  • The Passy Muir Valve has been shown to reduce tracheal secretions and the need for suctioning. In one study, there was a 40% reduction in secretion accumulation when the patients were using the Passy Muir Valve.6 In another study, a secretion rating scale significantly improved following use of the Valve.7


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Sources:

  1. Seidl, R., Nusse-Müller-Busch, R. & Ernst, A.(2005). The influence of tracheotomy tubes on the swallowing frequency in neurogenic dysphagia.Otolaryngol Head Neck Surg. 132(3):484-6
  2. Leder, S. & Suiter, D. (2013). Deglutition in patients with tracheostomy, nasogastric tubes and orogastric tubes. In Shaker et al. (eds.), Principles of Deglutition: A Multidisciplinary Text for Swallowing and Its Disorders (461-483). New York: Springer.
  3. Ohmae, Y., et al. (2006). Effects of one-way speaking valve placement on swallowing physiology for tracheostomized patients: impact on laryngeal clearance. Nippon Jibiinkoka Gakkai Kaiho. 109(7):594-9
  4. Prigent, H. et al. (2012). Effect of a tracheostomy speaking valve on breathing-swallowing interaction. Intensive Care Medicine. 38(1):85-90.
  5. Siebens, et al. (1993). Dysphagia and Expiratory Airflow. Dysphagia. 8(3):266-9.
  6. Lichtman, S. et al. (1995). Effect of a tracheostomy speaking valve on secretions, arterial oxygenation, and olfaction: a quantitative evaluation. Journal of Speech and Hearing Research. 38(3):549-55.
  7. Blumenfeld, L. (2012). The effect of tracheostomy speaking valve use on disordered swallowing. Oral Abstract Presented at Dysphagia Research Society Annual Meeting.