Enhancing Early Mobility With a Speaking Valve

Purpose Tracheostomy patients face many adversities including loss of phonation and essential airway functions including air filtering, warming, and humidification. Heat and moisture exchangers (HMEs) facilitate humidification and filtering of inspired air. The Shikani HME (S-HME) is a novel turbulent airflow HME that may be used in-line with the Shikani Speaking Valve (SSV), allowing for uniquely preserved phonation during humidification. The aims of this study were to (a) compare the airflow resistance ( R airflow ) and humidification efficiency of the S-HME and the Mallinckrodt Tracheolife II tracheostomy HME (M-HME) when dry (time zero) and wet (after 24 hr) and (b) determine if in-line application of the S-HME with a tracheostomy speaking valve significantly increases R airflow over a tracheostomy speaking valve alone (whether SSV or Passy Muir Valve [PMV]). Method A prospective observational ex vivo study was conducted using a pneumotachometer lung simulation unit to measure airflow ( Q ) amplitude and R airflow , as indicated by a pressure drop ( P Drop ) across the device (S-HME, M-HME, SSV + S-HME, and PMV). Additionally, P Drop was studied for the S-HME and M-HME when dry at time zero (T 0 ) and after 24 hr of moisture testing (T 24 ) at Q of 0.5, 1, and 1.5 L/s. Results R airflow was significantly less for the S-HME than M-HME (T 0 and T 24 ). R airflow of the SSV + S-HME in series did not significant increase R airflow over the SSV or PMV alone. Moisture loss efficiency trended toward greater efficiency for the S-HME; however, the difference was not statistically significant. Conclusions The turbulent flow S-HME provides heat and moisture exchange with similar or greater efficacy than the widely used laminar airflow M-HME, but with significantly lower resistance. The S-HME also allows the innovative advantage of in-line use with the SSV, hence allowing concurrent humidification and phonation during application, without having to manipulate either device.

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Passy-Muir Speaking Valve Use in a Children's Hospital: An Interdisciplinary Approach

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd18.2.76 ◽

2008 ◽

Vol 18 (2) ◽

pp. 76-86 ◽

Cited By ~ 2

Author(s):

Lauren Hofmann ◽

Joseph Bolton ◽

Susan Ferry

Keyword(s):

Tracheostomy Tube ◽

Pediatric Population ◽

Interdisciplinary Approach ◽

Extended Period ◽

Speech Development ◽

Tube Placement ◽

Background Information ◽

Speaking Valve ◽

Children's Hospital ◽

Children’S Hospital

Abstract At The Children's Hospital of Philadelphia (CHOP) we treat many children requiring tracheostomy tube placement. With potential for a tracheostomy tube to be in place for an extended period of time, these children may be at risk for long-term disruption to normal speech development. As such, speaking valves that restore more normal phonation are often key tools in the effort to restore speech and promote more typical language development in this population. However, successful use of speaking valves is frequently more challenging with infant and pediatric patients than with adult patients. The purpose of this article is to review background information related to speaking valves, the indications for one-way valve use, criteria for candidacy, and the benefits of using speaking valves in the pediatric population. This review will emphasize the importance of interdisciplinary collaboration from the perspectives of speech-language pathology and respiratory therapy. Along with the background information, we will present current practices and a case study to illustrate a safe and systematic approach to speaking valve implementation based upon our experiences.

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Exercise as early mobilization in patients using vasoactive drugs

Revista Brasileira de Fisiologia do Exercício ◽

10.33233/rbfex.v19i4.4249 ◽

2020 ◽

Vol 19 (4) ◽

pp. 301

Author(s):

Amanda Mariano Morais ◽

Daiane Naiara Da Penha ◽

Danila Gonçalves Costa ◽

Vanessa Beatriz Aparecida Fontes Schweling ◽

Jaqueline Aparecida Almeida Spadari ◽

...

Keyword(s):

Intensive Care ◽

Cardiovascular Response ◽

Ventilatory Support ◽

Early Mobilization ◽

Scientific Basis ◽

Routine Practice ◽

Vasoactive Drugs ◽

Early Ambulation ◽

Early Mobility ◽

The Face

Introduction: The functional benefits of Early Mobilization (EM) capable of minimizing limitations and deformities in the face of immobility are clear, but there are many barriers to conduct EM as a routine practice in the Intensive Care Unit (ICU), including the use of vasoactive drugs (VAD), since it is directly related to weakness acquired in the ICU, in addition to the resistance of the multidisciplinary team to mobilize the patient using VAD. Objective: The objective of this literature review is to raise a scientific basis in the management of critically ill patients using DVAs for EM in the ICU. Methods: It is an integrative review of the literature, with research in the databases: PEDro, Pubmed, Lilacs, with articles published between 2011 and 2018, in Portuguese and English, using the terms: vasoactive drugs, early mobility, exercise in UCI, vasopressor and its equivalents in Portuguese. Results: Nine studies were included that analyzed the EM intervention in patients using VAD, with or without ventilatory support. There was no homogeneous treatment among the researched works, varying between exercises in bed and outside, with passive and / or active action. However, regardless of the conduct, there was an improvement in the cardiovascular response without relevant changes regarding the use of VAD. Conclusion: EM is not contraindicated for patients in the ICU with the use of VAD, and it was shown to be effective and safe without promoting relevant hemodynamic and cardiorespiratory changes, which would determine its absolute contraindication.Keywords: vasodilator agents, early ambulation, intensive care units, physical therapy specialty.

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Benefits of Early Mobility on Sleep in the Intensive Care Unit

Critical Care Nursing Clinics of North America ◽

10.1016/j.cnc.2021.01.007 ◽

2021 ◽

Author(s):

Jaime Rohr

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Early Mobility

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Why is early mobility immobilized?

Heart & Lung ◽

10.1016/j.hrtlng.2021.01.002 ◽

2021 ◽

Author(s):

Mary Beth Happ ◽

Audrey S. Brockman ◽

Cynthia Moore

Keyword(s):

Early Mobility

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Result of closed interlocking intramedullary nail in tibial shaft fracture

Bangladesh Medical Journal Khulna ◽

10.3329/bmjk.v44i1-2.10470 ◽

2012 ◽

Vol 44 (1-2) ◽

pp. 15-17

Author(s):

AHSM Kamruzzaman ◽

S Islam

Keyword(s):

Intramedullary Nail ◽

Joint Stiffness ◽

Shaft Fracture ◽

Autogenous Bone ◽

Tibial Shaft Fracture ◽

Early Mobility ◽

Non Union ◽

Orthopedic Surgeons ◽

Interlocking Intramedullary Nail ◽

Diaphyseal Fractures

The management of tibial diaphyseal fractures has always held a particular interest for orthopedic surgeons. Not only they are relatively common but also they are often difficult to treat. This prospective study was carried out at Rangpur from April 2008 to November 2009. 34 patients were treated by closed interlocking intramedullary nail. Goal of this study was to find out a safe & effective management of fracture, early mobility of patient, functional joint motion and short stay in hospital. Routine follow up was carried out in 29 patients. In 24 cases, fracture (81.76%) were united, 4 cases (13.79%) needed dynamisation with autogenous bone grafting and 1 case devoloped non union. Study showed interlocking nailing in tibia provides early mobility of patients, reduces hospital stay and fracture unites without joint stiffness and less complication.DOI: http://dx.doi.org/10.3329/bmjk.v44i1-2.10470Bang Med J (Khulna) 2011: 44(1&2) 15-17

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