Pediatric tracheostomy speaking valves: A multidisciplinary protocol leads to earlier initial trials.

Abstract

Early speaking valve application in children with tracheostomies is encouraged for language development. Whether an institutional multidisciplinary protocol impacts the patient population and timelines for which a speaking valve is trialed has not been studied. This retrospective study compared speaking valve trials performed at a pediatric quaternary hospital over a 12-year period. Timelines (time between tracheostomy insertion, speech-language pathologist (SLP) consultation, speaking valve order, and trial) and patient characteristics (demographics, tracheostomy classification, and feeding status) were collected. Medians (IQRs) compared timelines before and after a protocol was instituted and compared the timelines between tracheostomy classifications. Median time between tracheostomy insertion and SLP consultation did not change: before protocol-1.8 (7.7) months and after protocol-1.8 (2.4) months. Time between tracheostomy insertion and speaking valve trial decreased: before protocol-34.1 (40.5) months and after protocol-12.9 (8.4) months. Time between tracheostomy insertion and trial was not different between tracheostomy classifications: upper airway obstruction-16.0 (27.1) months, complex medical condition-36.3 (45.8) months, and invasive ventilation-17.5 (22.3) months. An institutional multidisciplinary protocol decreases the time between tracheostomy insertion and speaking valve trial, regardless of the reason the tracheostomy is needed in the pediatric population.