[DYSPHAGIA] Trach and MBS

[SBuckie69@aol.com (SBuckie69@aol.com)]

I only have an abstract of the study done by Fleming, Stachler and Hamlet 
that used scintigraphy to measure pulmonary aspiration with and with out a 
speaking valve, and their study results indicate that the valve did reduce 
the incidence of pulmonary aspiration. I am wondering if it is because it 
overall improves the strength of the cough, and if material is aspirated, it 
would be better cleared with a closed system.

As far as, finger occlusion, I try to avoid that if at all possible, 
secondary to infection control isssues, yet ENT residents teach people to do 
this all the time. Also, it does not provide the more natural  phonatory 
control a valve does.

I still recommend a valve if I've got a patient who is aspirating with an 
open trache. I have yet to do a study where the patient is aspirating with an 
open trache, and then when I place the valve it immediately has the effects 
of preventing or reducing aspiration. However, if I am put in the position of 
doing a study with an open trache (again, something I like to avoid) and then 
do a repeat after PMV trials, I do see important improvement.  Yes, yes I 
know there could be a number of factors related to the improvement...

My two cents

Marcia Peterson Buckie
Sinai-Grace Hospital
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