Use it or lose it! A multidisciplinary protocol for early speaking valve use in children with tracheostomy

Background: Adults with tracheostomies demonstrate improved wellbeing, respiration and swallow by early use of a Passy Muir® speaking valve (PMV) (GPICS 2020). There are rising numbers of complex paediatric patients requiring tracheostomy, yet research is limited especially in timings of appropriate PMV use. Aim: In our tertiary hospital there was no MDT protocol, thus no PMV use for inpatients before 2017. A MDT protocol for PMV readiness and use was devised and implemented. We evaluated the protocol's impact on early, equitable and appropriate use of PMV in children with tracheostomies, including the ventilated population. Methods: Between 2018-2022, all children aged 0-18 years with a new tracheostomy during initial inpatient stay at our hospital were included. The use of the MDT protocol was retrospectively reviewed via a mixed methods approach; notes analysis, parental interviews and thematic analysis. Results: 20 patients were identified; 15 were ventilated. 17 of the 20 patients were assessed using the protocol. 10 of the 17 patients were deemed suitable for PMV trial and of these, 90% of trials were successful with continued PMV use at home. 70% of the successful trials were in ventilated patients using an inline PMV. Parental experiences of PMV use were positive for patients successful using the protocol. The failure of the remaining 3 patients was attributed to not using the protocol to discuss PMV use before the patient's trial. Conclusion: Consistent use of a MDT protocol facilitates early, equitable and successful PMV trials with high success rates and positive holistic outcomes for children and families, including in patients who are tracheostomy ventilated.