{"id":10169,"date":"2019-01-18T15:45:03","date_gmt":"2019-01-18T23:45:03","guid":{"rendered":"https:\/\/www.passy-muir.com\/?page_id=10169"},"modified":"2021-05-19T11:52:28","modified_gmt":"2021-05-19T18:52:28","slug":"journal-1-1-assessment","status":"publish","type":"page","link":"https:\/\/cloudfront.passymuir.com\/es\/journal-1-1-assessment\/","title":{"rendered":"Candidacy for Passy Muir \u00ae Valve Placement in Infants and Young Children: The Airway Assessment"},"content":{"rendered":"<div class=\"l3-header-con no-banner\">\n<div class=\"l3-header-icon\">\n\t\t<img decoding=\"async\"  src=\"\/wp-content\/uploads\/2017\/05\/Clinicians_0.png\" alt=\"journal\" \/>\n\t<\/div>\n<div class=\"l3-header-text\">\n\t\t\tAerodigestive Health\n                         <\/div>\n<\/p><\/div>\n<div style=\"clear:both\"><\/div>\n\r\n<ul class=\"breadcrumb\">\r\n\t<li class=\"active\">Clinician&apos;s Corner<\/li>\r\n\t<li class=\"dropdown\">\r\n\t\t<a href=\"#\" class=\"dropdown-toggle\" data-toggle=\"dropdown\">See All Articles <b class=\"caret\"><\/b><\/a>\r\n\t\t<ul class=\"dropdown-menu\">\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-ethical\">Impacting Patient Care and Ethical Considerations\r\n<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-management\">Understanding the Management of Patients Undergoing Prolonged Weaning...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-trach-tube-cuff\">Tracheostomy Tube Cuff: Purpose and Practice through Team Management\r\n<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-complications-management\">Case Study: Management of Complications Following SCI and the Role of SLPs...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-high-flow\">High Flow Oxygen Therapy and the PMV\u00ae<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-international-research\">Articles Representing International Research on Tracheostomy...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-1-1-protocol\">Having a Protocol for Clinical and Research Use of the Passy Muir\u00ae...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-1-1-candidacy\">Assessment Considerations for PMV\u00ae Candidacy in the Pediatric Population\r\n<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-1-1-assessment\">Candidacy for Passy Muir\u00ae Valve Placement in Infants and Young Children...\r\n<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-1-1-casestudy\">Keys to Success: A Pediatric Respiratory Therapy Case Study<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/talkmuir-6-1-perspective\">Physicians\u2019 Perspective on the Passy Muir\u00ae Speaking Valve<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/talkmuir-6-1-evidence\">Evidence Based Support for Using a PMV\u00ae In-line...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/talkmuir-6-1-effects\">Effects of PMV\u00ae In-line with Mechanical Ventilation...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/talkmuir-6-1-mechanical-vent\">Speaking Valve Use During Mechanical Ventilation...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/talkmuir-6-1-current-research\">Current Research Related to Mechanical Ventilation and Speaking Valve Use<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-dependence\">Infants and Children with Tracheostomy and Ventilator Dependence<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-protocol-transitioning\">From ICU to Home Care: A Protocol for Transitioning<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-complex-care\">Delivering Complex Care for Complex Children: A Multidisciplinary Approach<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-improving-communication\">Protocols Assist with Improving Communication for Patients...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-patient-outcomes\">Having Protocols for Clinical Use to Improve Patient Outcomes<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-oxygen-therapy\">Using the Passy Muir\u00ae Valve in Conjunction with High Flow Oxygen Therapy<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-pressure-swallow\">The Role of Pressures in Swallowing and Impact of the Passy Muir\u00ae Valve<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-relevance\">Clinical Relevance of the Sensorimotor Pathways in Dysphagia...<\/a><\/li>\r\n\r\n\t\t<\/ul>\r\n\t<\/li>\r\n<\/ul>\r\n\n<h1 class=\"journal--title\"><a href=\"\/wp-content\/uploads\/2016\/08\/Aerodigestive-Health_compressed.pdf#page=12\">Candidacy for <span class=\"pm_ws\">Passy Muir<\/span><sup>\u00ae<\/sup> Valve Placement in Infants and Young Children: The Airway Assessment<\/h1>\n<p><\/a><\/p>\n<h3 class=\"journal--speaker\">Suzanne Abraham, PhD, CCC-SLP<\/h3>\n<div class=\"about_author\"> <strong>About the Author<\/strong><br \/>\n \t \t<img decoding=\"async\" alt=\"Sue Abraham\" class=\"small_speaker\" src=\"\/wp-content\/uploads\/2019\/01\/Sue-Abraham.jpg\"\/><\/p>\n<div class=\"about_text\">\nSuzanne Abraham, PhD, CCC-SLP\n \t \t<\/div>\n<\/p><\/div>\n<div class=\"tom-image\"><img decoding=\"async\" alt=\"pediatric patient PMV007\" src=\"\/wp-content\/uploads\/2019\/04\/ped_patientl.jpg\"\/><\/div>\n<p>Assessment of the upper airway is a critical component for a comprehensive evaluation of any infant or very young child who has a tracheostomy. It is the analysis and interpretation of the data collected during the airway assessment that guides the decision-making regarding two critical quality of life issues for very young patients with tracheostomies and their families: (1) the route for nutritional intake and (2) candidacy for <span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span><sup>\u00ae<\/sup> Valve placement and wear time. Use of the <span class=\"pmv_ws\"><span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span> Valve<\/span> not only addresses neurodevelopment but also health-related quality of life. <\/p>\n<p>When we examine the airway of a baby with a tracheostomy, the primary goals are to determine the baby\u2019s baseline respiratory status and upper airway patency. To meet the goals, these two variables must be examined under two different clinical conditions: (1) the tracheostomy tube in the open mode and (2) the tracheostomy tube in the closed mode. The data collected under condition 1 and condition 2 are subsequently subjected to comparative analysis in the decision-making process of candidacy for <span class=\"pmv_ws\"><span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span> Valve<\/span> placement.<\/p>\n<p>Airway Assessment<br \/>\nI. Clinical Condition 1: Tracheostomy Tube in the Open Mode<br \/>\n&nbsp;I. a. Respiratory Criterion in the Open Mode <\/p>\n<ul>\n<li>No evidence of respiratory distress (RD) in the open mode <\/li>\n<li>No evidence of increased work of breathing (WOB) in the open mode <\/li>\n<ul>\n<li>No retractions in the region of the chest wall or chest cavity: suprasternal, substernal, intercostal, subcostal, or clavicular <\/li>\n<li>No nasal flaring <\/li>\n<li>No head bobbing <\/li>\n<li>No aberrant respiratory cycling <\/li>\n<\/ul>\n<\/ul>\n<p>I. b. Airway Patency Criterion in the Open Mode <\/p>\n<ul>\n<li>No evidence of airway obstruction in the open mode <\/li>\n<ul>\n<li>No noisy breathing<\/li>\n<li>No obstructive sounds associated with inspiration or expiration through the open tube <\/li>\n<li>Precaution: baseline breathing that produces an audible, dry sound can be a red flag\n<\/ul>\n<\/ul>\n<p>I. c. Secretion Criterion in the Open Mode <\/p>\n<ul>\n<li>No evidence of copious secretions in the open mode <\/li>\n<ul>\n<li>Check at the level of the oral cavity, larynx, or trachea <\/li>\n<\/ul>\n<\/ul>\n<div id=\"journal--block\">\nIf the baby with a tracheostomy meets criteria for the trach tube in the open mode, then continue on to Clinical Condition 2\n<\/div>\n<div id=\"journal--block\">\nIf the baby with a tracheostomy meets criteria for the trach tube in the open mode, then continue on to Clinical Condition 2: the \u201cTracheostomy Tube in the Closed Mode\u201d.\n<\/div>\n<p>II. Clinical Condition 2: Tracheostomy Tube in the Closed Mode<br \/>\n&nbsp;II. a. Transtracheal Pressures (TTP) <\/p>\n<ul>\n<li>Used to Measure<\/li>\n<ul>\n<li>End expiratory pressures (in centimeters of water pressure) during quiet breathing <\/li>\n<li>An indicator of airway patency at the level of the cannula <\/li>\n<\/ul>\n<li>Equipment <\/li>\n<ul>\n<li>Closed system, coupling the <span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span><sup>\u00ae<\/sup> Valve to a manometer <\/li>\n<\/ul>\n<\/ul>\n<ul>\n<li>Patient Requirements for TTP Procedure <\/li>\n<ul>\n<li>Quiet breathing only <\/li>\n<li>No audible tracheal secretions <\/li>\n<li>No crying <\/li>\n<li>No vocal behaviors <\/li>\n<li>No forced expiratory airflow, e.g., a reflexive or volitional cough <\/li>\n<\/ul>\n<li>What to Monitor During TTP: Data &#038; Analysis <\/li>\n<ul>\n<li>Complete 3 to 4 trials while maintaining quiet breathing <\/li>\n<li>With TTP in place, monitor the pressure that is registering on the manometer <\/li>\n<li>Each trial = 2 to 3 respiratory cycles as tolerated <\/li>\n<li>Calculate the average &#038; range of TTPs across trials <\/li>\n<\/ul>\n<li>TTP Criterion in the Closed Mode <\/li>\n<ul>\n<li>Average TTP in quiet breathing should be 6 cmH<sub>2<\/sub>O or less<\/li>\n<\/ul>\n<\/ul>\n<p>II. b. Tracheostomy Occlusion Trials <\/p>\n<ul>\n<li>What It Measures <\/li>\n<ul>\n<li>An indicator of airway patency above the cannula <\/li>\n<\/ul>\n<li>Equipment <\/li>\n<ul>\n<li>Gloved index finger <\/li>\n<\/ul>\n<li>How to Measure <\/li>\n<ul>\n<li>Finger occlude the hub of the tracheostomy tube completely and consistently by a gloved finger for the inspiratory and the expiratory phases throughout consecutive respiratory cycles <\/li>\n<\/ul>\n<li>Patient Requirements for Tracheostomy Occlusion Procedure <\/li>\n<ul>\n<li>Compliant for complete occlusion of the hub of the tracheostomy tube <\/li>\n<\/ul>\n<li>What to Monitor During Tracheostomy Occlusion Trials: Data &#038; Analysis <\/li>\n<ul>\n<li>Tolerance for the number of respiratory cycles of consistent and complete occlusions of the tracheostomy tube <\/li>\n<li>Observe for respiratory distress signs and increased WOB across respiratory cycles in closed mode <\/li>\n<li>Listen for any obstructive sounds, which can be wet or dry <\/li>\n<li>Determine the presence or absence of airflow from mouth and nose in the closed mode <\/li>\n<\/ul>\n<li>Trach Occlusion Criteria in the Closed Mode <\/li>\n<ul>\n<li>Tolerance for a minimum of 10 consecutive respiratory cycles in the closed mode <\/li>\n<li>During consistent, complete occlusion of the tube: <\/li>\n<ul>\n<li>Confirm inspired &#038; expired airflow from the mouth or nasal passage(s) <\/li>\n<li>Observe no evidence of respiratory distress or WOB <\/li>\n<li>Hear no audible obstructive sounds <\/li>\n<li>Observe no build-up of secretions at the oral, nasal, or laryngotracheal level<\/li>\n<\/ul>\n<\/ul>\n<\/ul>\n<p>The data collected under condition 1 and condition 2 are subsequently subjected to comparative analysis in the decision-making process of candidacy for <span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span><sup>\u00ae<\/sup> Valve placement. If the infant or very young child with a tracheostomy meets respiratory, airway patency, and secretion criteria in the open mode (condition 1) and meets criteria for TTPs, trach occlusion trials, and associated respiratory, airway patency, and secretion criteria in the closed mode (condition 2), then advancing the tracheostomized baby to initial wear time trial of <span class=\"pmv_ws\"><span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span> Valve<\/span> placement is indicated. If the baby does not meet criteria for condition 1 or 2, then candidacy for PMV placement should continue, albeit with the addition of appropriate medical and clinical collaborative problem-solving. <\/p>\n<p>This article is from the Fall 2017 Pediatric Issue of Aerodigestive Health. <a href=\"\/wp-content\/uploads\/2016\/08\/Aerodigestive-Health_compressed.pdf#page=12\">Click here<\/a> to view Candidacy for <span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span><sup>\u00ae<\/sup> Valve Placement in Infants and Young Children: The Airway Assessment.<\/p>\n<hr>\n<h4>References:<\/h4>\n<ol>\n<p>Abraham, S. (1997). Little tikes with trachs + <span class=\"pm_ws\">Passy Muir<\/span>: Airway safety, secretions, swallow. [Abstract]. ASHA, 39(10), 179.<\/p>\n<p>Abraham, S. and Gereau, S. (1995). Tracheostomized pediatric patients + <span class=\"pm_ws\">Passy Muir<\/span>: Protocol for candidacy. [Abstract] ASHA, 37(10), 7.<\/p>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"Aerodigestive Health Candidacy for <span class=\"pm_ws\"><span class=\"pm_ws\">Passy Muir<\/span><\/span><sup>\u00ae<\/sup> Valve Placement in Infants and Young Children: The Airway Assessment Suzanne Abraham, PhD, CCC-SLP About the Author Suzanne Abraham, PhD, CCC-SLP Assessment of the upper airway is a critical component for a comprehensive evaluation of any infant or very young child who has a tracheostomy. It is the analysis [&hellip;]","protected":false},"author":6,"featured_media":12190,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"yst_prominent_words":[1611,1575,1535,1534,1598,1609,1606,1608,1538,1594,1613,191,1536,1610,2110,89,1602,1604,1612,1596],"class_list":["post-10169","page","type-page","status-publish","has-post-thumbnail","hentry"],"_links":{"self":[{"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/pages\/10169","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/comments?post=10169"}],"version-history":[{"count":28,"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/pages\/10169\/revisions"}],"predecessor-version":[{"id":10197,"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/pages\/10169\/revisions\/10197"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/media\/12190"}],"wp:attachment":[{"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/media?parent=10169"}],"wp:term":[{"taxonomy":"yst_prominent_words","embeddable":true,"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/yst_prominent_words?post=10169"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}