Journal Article

P147 A novel approach to the use of an adjustable one-way valve in paediatric tracheostomy patients with complex airways: a case series

De, Bolfo J, Judge, S, Ritchie, L, Shaw, C

2025

Overview

Introduction and objectivesThere are many benefits to one-way valve use including restoring physiological PEEP, improving postural tone, vocalisation and re-sensitisation of the upper airway. Our organisation adopts a multidisciplinary pathway to establish appropriateness for one-way valve assessment. Our clinical experience shows that a small proportion of our caseload do not tolerate closed bias valves. We present 8 paediatric cases and evaluate the tolerance and patient experience in terms of vocalisation/communication, tracheobronchial secretion management and feeding/swallowing when wearing the Atos Medical TRACOE® Phon Assist I one-way valve.MethodsData was collected for 8 paediatric patients, demographics are detailed in table 1. Additional data was collated from the clinical assessment including Transtracheal pressure (TTP)manometry. TTP was compared between the two valve types. Likert rating scales and a semi structured parent/carer interview followed by thematic analysis.ResultsOf the 8 sets of data for children using the TRACOE® Phon Assist I one-way valve, one was excluded from full analysis as they were transferred to a different tertiary hospital. Our data showed where a closed bias-valve resulted in high TTP and non-tolerance, use of the TRACOE® Phon Assist I one-way valve resulted was well tolerated (table 1).All parent/carer responses reported a positive change in communication/vocalisation. The top ranking theme (86%) was that the vocalisation was louder with the valve on. Six (86%) responses reported a positive change in tracheobronchial secretion management. No (0%) responses reported a change in oral feeding. The top ranking theme stated by 6 (86%) was that the child was tube fed.Abstract P147 Table 1Demographic and Transtracheal Pressure measurements: TRACOE® Phon Assist I one-way valve vs closed bias ValveConclusionsThe findings of this study show that for paediatric patients who do not tolerate closed bias one-way valve, that the TRACOE® Phon Assist I one-way valve provides a safe and well tolerated alternative. The infinitely adjustable side openings allow adjustment of breathing resistance which facilitates airflow through the upper airway and out the side openings aiding tolerance. Our small but complex population of paediatric tracheostomy patients who do not tolerate closed bias one-way valves, can now to gain the benefits associated with use of one-way valves by using the TRACOE® Phon Assist I one-way valve.

• Publisher: BMJ Publishing Group LTD
• Subject: Bias / Ostomy / Pediatrics / Tracheotomy / Valves