{"id":1229,"date":"2017-06-30T17:23:29","date_gmt":"2017-06-30T17:23:29","guid":{"rendered":"http:\/\/localhost:8080\/mywordpress\/how-early-in-recovery-from-traumatic-brain-injury-can-a-passy-muir-valve-be-used\/"},"modified":"2019-01-09T12:52:56","modified_gmt":"2019-01-09T20:52:56","slug":"tbi_acs","status":"publish","type":"page","link":"http:\/\/1.passy-muir.com\/es\/tbi_acs\/","title":{"rendered":"How early in recovery from traumatic brain injury can a Passy Muir\u00ae Valve be used?"},"content":{"rendered":"
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\n\t\t\tHow early in recovery from traumatic brain injury can a Passy Muir<\/span><\/span> Valve<\/span> be used?\n <\/div>\n<\/p><\/div>\n
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Assessment of cognitive function may begin very early in patients with severe traumatic brain injury, often as soon as patients begin emerging from a deep coma.1-3<\/sup> One assessment that may be used with this patient population is The Rappaport Coma\/Near Coma Scale, a rating tool that assists with monitoring patient response to various stimuli across all sensory domains.1<\/sup> A patient\u2019s ability to vocalize or verbalize is included as a factor in this assessment. Responses to strong odors, visual, tactile, and painful stimuli are also rated. <\/p>\n<\/div>\n

Often patients who are minimally conscious require a tracheostomy to support respiratory function. However, an open tracheostomy tube does not allow air\ufb02ow through the oral and nasal tracts which impacts access to sensory inputs such as olfaction and taste and diminishes the ability to vocalize or verbalize responses. Since sensory awareness and verbalizations are often included in the assessment of these low-level TBI patients, measurement of function may be altered, and therapeutic plans based on the assessment may be misguided. <\/p>\n

Use of the Passy Muir<\/span>\u00ae<\/sup> Valve can begin after the original placement of the tracheotomy tube and when the multidisciplinary team deems the patient ready. Early placement of the Passy Muir<\/span><\/span> Valve<\/span> can restore air\ufb02ow to the upper airway allowing increased vocalizations and awareness of sensory stimulation, thus providing more complete and meaningful assessment and impacting recovery.<\/p>\n

The presence of a tracheostomy tube with an in\ufb02ated cuff has signi\ufb01cant effects on swallowing frequency and effectiveness due to decreased laryngeal excursion, subglottic pressure and oropharyngeal sensitivity.4-6<\/sup> In a study by Seidl, Nusser-M\u00fcller-Busch, and Ernst,4<\/sup> tracheostomy tubes were determined to affect swallowing function in vegetative patients. The researchers reported that for patients with a Glasgow Coma Scale score below eight points, the presence of the tracheotomy tube decreased the swallowing frequency. Removal of the tracheostomy tube signi\ufb01cantly improved swallowing frequency for this group of patients.<\/p>\n

Therefore, Seidl et al. recommend de\ufb02ation of the cuff or removal of the tracheostomy tube as a therapeutic measure to improve swallow function based on the improved sensitivity that occurs with re-established physiology in the upper airway. For patients not ready for decannulation, cuff de\ufb02ation and early use of the Passy Muir<\/span><\/span> Valve<\/span> may signi\ufb01cantly contribute to the improvement of swallow safety and efficiency by not only restoring expiratory air\ufb02ow physiology but also re-establishing the bene\ufb01ts of subglottic pressure.5<\/sup> With these noted potential benefits, use of the Passy Muir<\/span><\/span> Valve<\/span> early in recovery should be considered.<\/p>\n

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