Effect of the Passy-Muir tracheostomy speaking valve on pulmonary aspiration in adults

Purpose We determined instances of aspiration in adults with tracheostomies and investigated the effect of the Passy-Muir tracheostomy speaking valve on occurrences of aspiration.Methods Adults with tracheostomies scheduled for videofluoroscopic swallowing examinations who met inclusion criteria were enrolled. According to study protocol, 6 presentations of thin liquids were recorded, 3 with and 3 without the Passy-Muir tracheostomy speaking valve. If a cuffed tube was present, the cuff was deflated fully for all presentations.Results Seven of 15 subjects aspirated material on 1 or more presentations of thin liquid. Five subjects aspirated material only with the Passy-Muir tracheostomy speaking valve off, whereas 2 subjects aspirated material with and without the valve. No subject aspirated material while the valve was on exclusively. Aspiration was significantly less frequent with the Passy-Muir tracheostomy speaking valve on than with it off.Conclusions Clinically unapparent aspiration occurs commonly in patients with tracheostomies. An expiratory occlusive valve can reduce, though not eliminate, occurrences of aspiration.Clinical implication The benefit of the Passy-Muir tracheostomy speaking valve should be evaluated in selected patients who aspirate liquid.