Ventilator-Assisted Living©

Spring 2004, Vol. 18, No. 1

ISSN 1066-534X

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Read selected articles from this issue ...

Passy-Muir Speaking Valve: Improving Voice in Children and So Much More
Lori Fitsimones, MS, CCC-SLP, University of Florida, Dept of Communicative Disorders & Shands Rehabilitation Hospital, Gainesville, Florida
Sidebar: How the Passy-Muir Valve Works

Ventilator Backup: Are You Prepared?
Larry Kohout, Edina, Minnesota
Bill Miller, Leesburg, Florida

Aging and Respiratory Function
Anita Simonds, MD, FRCP, Royal Brompton Hospital, London, England

Transition: From Middle Age to Elderly
Lawrence C. Becker, Roanoke, Virginia

Mouth Intermittent Positive Pressure Ventilation:
An old technique revisited for a "sip" of fresh air

Miguel R. Gonçalves, PT, and João Carlos Winck, MD, PhD, Rehabilitation and Lung Function Unit, Pneumology Department, Hospital São João, Faculdade de Medicina-Porto, Portugal

Arizona Respiratory Center Receives Grant
John D. Mark, MD, Director, Southwest Ventilation Program, Universtiy of Arizona Health Sciences Center, Tucson, Arizona

ALS Respiratory Care Resources

Respironics Colorado Announces Discontinuation of Service and Repair Support
for Certain Ventilation Equipment

Statement from Respironics, Inc.
Statement from J.H. Emerson Co.

IVUN Ventilatory Equipment Exchange

New Interface: The ComfortLite from Respironics

Passy-Muir Speaking Valve: Improving
Voice in Children and So Much More

Lori Fitsimones, MS, CCC-SLP, University of Florida, Department of Communicative Disorders and Shands Rehabilitation Hospital, Gainesville, Florida

David Muir, a young ventilator user due to Duchenne muscular dystrophy, conceptualized a one-way valve that would allow him to speak while using his ventilator. In 1985, David met Patricia Passy who partnered with him to form Passy-Muir, Inc. Together, they developed his idea into the Passy-Muir Valve (PMV) that is now used by children and adults in more than 30 countries.

When David died in 1990 at the age of 23, he knew his invention would help those who knew how to speak but were unable to produce voice. But could he have foreseen that his invention would help infants and young children to learn communication?

Infants and children with a tracheostomy lose their ability to make sounds, produce differentiated cries and form words that are critical to language development. The earliest vocalizations, such as babbling, cooing and crying, enable infants to interact with their world and bond with caregivers. These also trigger formation of neuro-developmental pathways. Wearing a PMV restores the ability of infants and children to vocalize, enabling them to perform these critical vocal behaviors. In addition to improving vocalization, the PMV may also improve swallowing ability and eliminate and/or reduce aspiration.

Lloyd and Renée Pinel claim that placing a PMV on their 9-day-old daughter, Elizabeth, has been pivotal in her development. Elizabeth, born with Pierre-Robin syndrome, required immediate tracheostomy after birth. Wearing a PMV all day not only allows Elizabeth to babble to her heart’s content, but it also provides an avenue for oral stimulation even though she receives non-oral tube feedings. Elizabeth sucks on a bottle during tube feedings to take advantage of the increased upper airway sensation caused by exhaled airflow. This promotes normal oral development. Her parents claim that one of the greatest benefits of using the PMV is that it enables Elizabeth to cough and clear her own secretions more effectively, decreasing suctioning needs. Renée states it is nice to drive her boys to hockey games without having to repeatedly pull over to suction baby Elizabeth.

Many parents struggle with the emotional impact of having a child born with medical complications, and health care practitioners must bear in mind how early placement of a PMV can help the parents. Lynne Lockey, whose son was born with vocal cord paralysis, states, “The experience of delivering a child who had to be trached at birth was so overwhelming and so draining. I felt like I had been cheated. When little Willie got his PMV, I felt lucky to hear my son cry for the first time. I only wish we could have gotten the valve sooner.”

Clearly the PMV is more than just a speaking valve. It facilitates a more natural use of the upper airway for improved sensation, secretion management, swallowing and voice production. It allows the youngest of patients to audibly laugh, cry, coo, babble and connect with the world around them by communicating in a way that transcends words.

How the Passy-Muir Valve Works

Although other speaking valves are available, the PMV is the only speaking valve FDA-approved for in-line use with a ventilator. Because of its bias-closed feature, it is also the only one found to have a positive impact on swallowing and oxygenation in addition to facilitating voice.

The valve consists of a plastic shell that attaches to the external end of the tracheostomy. Inside is a thin, pliable plastic diaphragm that attaches at its center to a set of “crossbars” traversing the valve face. This diaphragm remains closed until the individual actively inhales. When air is no longer being inhaled, the valve automatically closes. The exhaled air then flows past the tracheostomy (if a cuffed tube is used, the cuff must be deflated) and through the vocal cords enabling speech. This bias-closed feature causes a column of air to remain inside the tracheostomy which acts as a buffer to prevent secretions from traveling up the tracheostomy to block the valve.

The original version of the PMV (PMV 005) is still available, and four additional versions have been developed. The best way to determine an individual’s candidacy for a PMV is to employ a team approach with a respiratory therapist, speech-language pathologist, nurse and physician.

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