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- W948969439 abstract "You have accessThe ASHA LeaderInbox1 Jul 2009Speaking Valve Not Always Best Ann E. F. Sievers, and Rebecca Leonard Ann E. F. Sievers Google Scholar More articles by this author and Rebecca Leonard Google Scholar More articles by this author https://doi.org/10.1044/leader.IN2.14092009.4 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In This letter is in response to “Patients Requiring Tracheostomy and Mechanical Ventilation: A Model for Interdisciplinary Decision-Making” (Jan. 20, 2009). It is good to see different disciplines bring their perspectives to patients who require tracheostomy and mechanical ventilation. Efficient evaluation that decreases time required for ventilator support and need for tracheostomy is critical. As an advanced practice nurse with 30 years' experience in otolaryngology and as a speech-language pathologist with an interest in voice and swallowing, we must take issue with the practice of using speaking valves with surgical tracheostomy tubes with deflated cuffs. Because of the mechanics of airway dynamics and laminar flow, tracheostomy tubes are usually large to allow for the greatest internal diameter for ventilation. The large, redundant cuffs distribute cuff pressures on the trachea and prevent stenosis. Even with the cuffs deflated, the larger tubes and redundant cuffs take up a sizeable amount of the airway. For spontaneously breathing patients, it is more efficient to change to a smaller, cuffless tube. Consider the size of the airway and the amount of obstructed airspace in the trachea and then downsize to a cuffless tube to speed the decanulation process, which is the clinical goal. If this procedure is tolerated, the tracheostomy tube can be capped for normal, humidified airflow through the upper airway, also allowing speech. Speaking valves are a tool, but airway dynamics cannot be overlooked. Because a useful tool is available that can enhance speech does not mean that it is the correct or most efficient one. Author Notes Ann E. F. Sievers, Sacramento, California [email protected] Rebecca Leonard, Sacramento, California Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 14Issue 9July 2009 Get Permissions Add to your Mendeley library History Published in print: Jul 1, 2009 Metrics Current downloads: 368 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2009 American Speech-Language-Hearing AssociationLoading ..." @default.
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- W948969439 title "Speaking Valve Not Always Best" @default.
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