Giving Vented Patients a Voice

\"speechBy Susan Becker, M.S. CCC/SLP

Speech-Language Pathologist

Specialty Hospital  is committed to assisting patients in communicating with staff and family.  Many of our patients have a tracheostomy tube or are ventilator dependent and unable to use voice to communicate their wants and needs.  These patients are given a communication board upon admission, while others attempt to communicate by mouthing words.  Patients are screened by the Speech Pathologist and the Respiratory therapist to assess candidacy for the Passy Muir Speaking Valve (PMV).

The PMV is utilized with ventilated and tracheostomy dependent patients.  The PMV is a one way valve that is placed on the hub of the tracheostomy tube or in-line with the ventilator system.  The valve on the PMV is in the open position when the patient is inhaling and the valve closes when the patient is exhaling.  In the closed position the patient’s airflow is then redirected through the vocal folds, mouth and nose allowing for voice production.  Some patients adjust to the valve immediately and are able to produce voice. Others may take longer to adjust as breathing with the valve in place can be challenging.  Patients with a tracheostomy tube work hard to build up their tolerance for wearing the PMV for increasing amounts of time.

Specialty Hospital of Central Jersey has been using the Passy-Muir speaking valve in-line with ventilated patients since August 2016 following a multidisciplinary approach in patient care management. The team consists of physicians, nurse practitioners, physician assistants, respiratory therapist and, speech language pathologists.  Admitted ventilator dependent patients are screened within 24-48 hours for consideration in the program.  The respiratory therapist and speech language pathologist review potential patients prior to clearing the patients with the nurse practitioner, physician, and/or physician assistant.

Patients who pass the screening process proceed to a three step process.  After successful completion, patients continue with inline PMV placement as tolerated or until they are weaned from the ventilator.  Since its inception, 57 patients have met the requirements for the program and have successfully produced voice with the in-line PMV.

The inline PMV program is an integral part of the weaning process at Specialty Hospital of Central Jersey.  This program allows our patients who do not communicate on the ventilator to have a voice.  It is an emotional experience for the patients, families and therapists involved as many of these patients have not spoken in weeks  sometimes  months.

We frequently hear patients express comments such as “I can talk,” or “thank you for giving me a voice.”  Patients are then able to participate in their care and express pain levels as they speak with the team.  For the families hearing a simple “I love you, ““I’m doing alright,” or even a patient’s final goodbyes is invaluable.  This program allows patients to communicate with the healthcare team, their families and be an active participant in their care.

Questions or concerns? Please don’t hesitate to contact me at 732-232-4628.

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