Measurement of End-Expiratory Pressure as an Indicator of Airway Patentcy above Tracheostomy in Children
Jongrak Utrarachkij, MS*, Jeeraporn Pongsasnongkul, BSc*, Aroonwan Preutthipan, MD, FCCP**, Teerachai Chantarojanasri, MD**
Affiliation : * Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University ** Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
The tracheostomy speaking valve is a one-way valve that closes during exhalation. It causes redirection of exhaled gas into the larynx, mouth and nasal cavity, thus enabling children with long-term tracheostomies to speak. Whether a child can tolerate the valve depends mainly on the patency of the upper airway around and above the tracheostomy tube. To measure end-expiratory pressure (EEP) at the tracheo- stomy tube when the speaking valve is being put in place may be a useful noninvasive tool to assess the patency of the exhalation pathway. The authors, therefore, measured EEP when the patients were first put on the speaking valves and tried to follow-up the patients thereafter. Twenty-two tracheostomized children (aged 3.2 months to 17 years, male/female 16/6) were recruited for the present study and EEP was measured. It was found that 13 children having the EEP in the range of 2-6 cmH2O could breathe normally through the valves and later could use the valves without any problems, whereas 9 children with EEP in the range of 10- 40 cmH2O demonstrated breathing difficulties and the valves had to be taken off immediately. Bronchoscopy revealed upper airway narrowing in all of those children with unsuccessful valve placements. It was concluded that EEP was exceedingly high in children with upper airway narrowing. The measurement of EEP via speaking valves can, thus, be used as an objective indicator to evaluate the patency of upper airway proximal to the tracheostomy tube.
Keywords : Tracheostomized children, Ttracheostomy speaking valve, End-expiratory pressure, Assessment of the upper airway pathology
