Upper Airway Assessment for One-Way Valve Use in a Patient With a Tracheostomy

Sutt, A. L., Wallace, S., & Egbers, P. (2021). https://doi.org/10.1044/2021_AJSLP-21-00174

Abstract: We read with great interest the recent study by Li et al. (2021), where they describe comparative methods to assess upper airway patency in patients with tracheostomies. We welcome this study in increasing awareness of an important subject; however, we would like to raise questions regarding the methodology used. Upper airway patency is not only essential for successful decannulation, but also equally important to establish prior to using a one-way valve. Li et al. discuss upper airway patency; however, they do not clearly distinguish between the two aspects that need consideration in establishing the safety of a one-way valve: the anatomical integrity of the upper airway (the area above the tracheostomy) and the space around the tracheostomy cannula and the cuff—the latter of which, even when deflated, can pose difficulties for patients to be able to freely breathe around it. The essence of using a one-way valve is that all exhaled gas must pass the upper airway. Any assessment of upper airway patency should therefore include both of these aspects to ensure mitigation of risks and prevention of harm to patients (Heimer et al., 2019).