Does Endurance Improve with the Use of Pass-muir Valve for Patients with Tracheostomy?

Research Objectives: To determine if the use of the Passy-Muir Speaking Valve (PMV) impacts the endurance of patients with a tracheostomy tube while completing physical therapy (PT).

Design: Prospective two-to-six session randomized crossover controlled study. The study was prospectively registered with ClinicalTrials.gov (NCT04941456).

Setting: Gaylord Hospital, a 137-bed long-term acute care hospital (LTACH), located in Wallingford, Connecticut, USA.

Participants: Eligible participants were patients admitted to Gaylord Hospital who were 18 years and older with a tracheostomy tube and were able to ambulate a minimum of 10 feet, tolerate daily 30-minute PT sessions with the use of a PMV, and maintain O2 saturations above 88% with exertion. Twenty-six patients consented to participate, with 24 participants providing partial or complete datasets adequate for analysis. Two datasets were excluded; 1 participant was discharged following session 1, and 1 participant incidentally completed two PMV sessions.

Interventions: Participants completed alternating study sessions in which they either wore a PMV or maintained an open tracheostomy tube. They then completed the six-minute walk test (6MWT) to the best of their ability. To be included in the data collection, participants had to complete a minimum of two study sessions (one with a PMV and one with an open tracheostomy). Group A started the sequence with a PMV in place, while Group B started the sequence with an open tracheostomy tube.

Main Outcome Measures: 6MWT, Borg Rating of Perceived Exertion (RPE), O2 saturation, heart rate, ambulation distance, and ambulation time.

Results: Statistical analysis was limited to the first PMV and first Open Tracheostomy session due to the lack of paired data following session two. Mean (95% CI) ambulation distance was not statistically different between the PMV condition (413.0 [266.1 – 560.0]) and the open tracheostomy condition (387.0 [259.8 – 514.1]) (p=0.2795; Paired t-test). Similarly, change in heart rate (p=0.1086; Paired t-test), RPE (p=0.5361; Wilcoxon matched-pairs signed rank test), O2 (p=0.3129; Paired t-test), and average 6MWT time (p=0.9515; Wilcoxon matched-pairs signed rank test) were not statistically different between the PMV and open tracheostomy conditions.

Conclusions: PMV status did not impact participants’ ability to complete the 6MWT, with participants performing similarly with a PMV or with an open tracheostomy. This indicates that the patient may safely use the PMV during PT and other supervised physical activities. Given the PMV's other known benefits, such as communication, its use during PT comes down to patient preference and comfort.

Author(s) Disclosures: None