- Passy-Muir Valve
- facilitation of speech in the tracheostomized patient
- valve designed to eliminate the necessity of finger occlusion for the patient with a tracheostomy tube while allowing the patient uninterrupted speech.
- one way valve that allows inspiration via trachy and then during expiration the valve remains closed without leakage.
METHOD OF INSERTION AND/OR USE
- must be awake, responsive and attempting to communicate
- must have appropriate lung mechanics to exhale around the tracheostomy tube
- must be able to tolerate cuff deflation
- must have minimal secretions
- when ready -> place over tracheostomy
- Unconscious / comatose patient
- Inflated tracheostomy tube cuff
- absent cuff leak when deflated
- Severe upper airway obstruction that may prevent sufficient exhalation
- Excessive secretions
- Severe COPD with gas trapping
- Foam filled cuff tracheostomy tube (eg Bivona)
- Endotracheal tube
- doesn’t require a fenestrated tracheostomy
- fits on universal 15mm hub
- oxygen and humidification can be administered via the tracheostomy collar
- can be attached to the tracheostomy ties for ease of attachment and detachment
- can be used in ventilator dependent patients
- reusable, wash in warm soapy water
- can last 2 months
- airway obstruction if patient is unable to exhale around tracheostomy
- tracheostomy blockage
- strong cough may blow off valve
- WOB may increase
Anatomy and physiology
Complications of tracheostomy
Cuff deflation and placement of PMV
Clinical benefits of PMV
Mechanical ventilation with PMV
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.