The combination use of a Japanese-ready-made fenestrated speaking cannula and speaking valve in children with tracheostomy

Objectives

A Japanese-ready-made fenestrated speaking cannula (SC) and a one-way speaking valve (SV) were actively used in children with tracheostomy in our hospitals. We reviewed our experience, focusing on the laryngeal function.

Methods

Eleven children who underwent tracheostomy using an SC and SV were retrospectively analyzed. Confirmation of steady spontaneous breathing and, when feasible, a patent upper airway and the position of the side holes of the SC in the trachea by rigid bronchoscopy were necessary.

Results

Tracheostomy reasons included upper airway stenosis (six cases) or respiratory failure due to primary disease (five cases). Intratracheal granulation due to SC was not observed. Regarding breathing, in ten cases, the amount of tracheal secretions and the frequency of intratracheal suctioning were lower than before SC-SV use. Regarding vocalization, while dysphonia (seven cases) and inspiratory phonation (two cases) were observed before SC-SV use, all cases acquired vocalization during SC-SV use. Regarding swallowing, the five patients who showed aspiration before SC-SV use achieved a normal swallowing function (four cases) or silent aspiration (one case) during SC-SV use. Decannulation was attempted under SC-SV use, depending on the conditions. Seven patients have achieved decannulation, and in three patients, the size of the SC has decreased, permitting future decannulation.

Conclusion

With the combined use of the Japanese-ready-made SC and SV for children with tracheostomy, the laryngeal function improved physiologically. The change in airflow contributed to a reduction in tracheal secretions, acquisition of vocalization, and prevention of aspiration. An SC-SV also seems to facilitate future decannulation.