Analysis of Trans-Tracheal Measurements in Children Wearing SpeakingValves during Sleep

Purpose: There is some evidence supporting the safety of speaking valve use for tracheostomy patients during sleep. The purpose of this study is to further validate the safety of speaking valve use while asleep with the use of trans-tracheal manometry by comparing expiratory pressure measurements while the patient is awake and asleep. Materials & Methods: Children, ages 1-18 years, who routinely wear a speaking valve during wake periods, were included in this single center, non-randomized study. Subjects’ vital signs, end tidal CO2, and trans-tracheal pressures were monitored, while awake and sleeping during a 24-hr period. Data was collected for each patient, including sleep status and whether or not they were wearing the speaking valve, at the times data were collected. Data was analyzed via means & 95% confidence intervals. Results: 8 patients were included in the study. Trans-tracheal manometry measurements taken while patients were awake versus asleep, wearing the speaking valve, showed no statistically significant difference (awake: 12.25cm H2O vs. asleep: 8.98cm H2O; p=0.38). No significant differences in patient’s vital signs or end-tidal carbon dioxide values were noted between times when patients were awake or asleep while wearing the speaking valve. No major adverse events were recorded during the 24 hour study period. Conclusions: This study further supports that a speaking valve can be safely used during sleep in children with tracheostomy tubes. Objective parameters using vital signs and trans-tracheal pressure manometry can safely evaluate children who use the speaking valve during sleep periods. The management of children that are tracheostomy dependent can be improved by obtaining the full benefits of wearing a speaking valve.