• Douglas Clark Johnson, Stacy Lynn Campbell, and Judith Dawn Rabkin.
• Spaulding Rehabilitation Hospital, Boston, MA 02114, USA. djohnson5@partners.org
• Clin Respir J. 2009 Jan 1;3(1):8-14.

IntroductionReadiness to speak is a major problem for many tracheostomized patients. Evaluation for tracheostomy tube capping or speaking valve is often subjective.ObjectivesWe first wanted to assess whether there were differences among speaking valves. We developed a care pathway for tracheostomy tube evaluation and management including manometry, which we wanted to evaluate.MethodsThree different speaking valves were assessed using manometry and measuring dyspnea in 21 patients. Subsequently, 100 consecutive patients referred for tracheostomy tube evaluation in a long-term acute-care rehabilitation hospital were studied using our care pathway with manometry before and after tracheostomy tube changes.ResultsInspiratory pressures differed among the speaking valves. Borg scale was higher among patients with high expiratory pressures. Of the 100 patients, following our care pathway, speech (speaking valve or capping) was recommended for 78 patients with their initial tube, and for 93 patients within 2 days of their initial evaluation. Tracheostomy tube downsizing was recommended in 94 patients. Downsizing led to significant reductions in airway pressures. Capping was initially recommended for 12 patients and for 71 following downsizing. Women had higher pressures than men for the same size tubes.ConclusionTracheostomy tube manometry is very helpful in objectively guiding recommendations for speaking valve use, capping, and changing tracheostomy tubes. Speech is an early recommendation for most patients.

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