Toleration of a Speaking Valve Placed In-Line With the Ventilator Circuit in Critically Ill Tracheostomized Patients

Background Being deprived of the ability to speak is a dehumanizing experience for critically ill patients receiving prolonged mechanical ventilation support in the intensive care unit (ICU). A speaking valve is often used only once a patient with a tracheostomy can be disconnected from the ventilator. Objective To study the toleration of a one-way speaking valve connected in-line with the ventilator circuit in ICU patients with chronic critical illness and a tracheostomy. Methods A retrospective cohort study was conducted in a 15-bed ICU and a 5-bed post-ICU weaning center from October 2021 through February 2024. All patients had undergone tracheostomy placement in the ICU because of difficulty with weaning from mechanical ventilation. Results Of the 47 included patients, the in-line speaking valve trial was unsuccessful in only 4 (9%). Three of the patients in whom the trial was unsuccessful had severe obesity (no patients with successful trials had severe obesity, P < .001) and the fourth patient had severe laryngeal dysfunction. Patients in whom the in-line speaking valve trial was successful could be maintained under this mechanical ventilation modality until they were fully disconnected from the ventilator. Conclusions An in-line speaking valve trial was successfully performed in most of the patients with a tracheostomy. An in-line speaking valve can safely restore the natural way of communication for ventilator-dependent critically ill patients with tracheostomies. Larger studies are needed of patients with severe obesity or severe laryngeal dysfunction.