The Effect of the Passy-Muir® Valve on Disordered Swallowing

Liza Blumenfeld MA, CCC-SLP

At the 2012 Dysphagia Research Society Conference held in Toronto, Canada, Liza Blumenfeld MA, CCC-SLP from Scripps Memorial Hospital in La Jolla, California presented a scientific paper on the effect of the Passy-Muir® Valve use on disordered swallowing. I had the opportunity to meet Ms. Blumenfeld and ask her about what prompted her interest in studying the Passy-Muir Valve. She told me that she has been working with tracheostomized and ventilator-dependent patients for the last 16 years. She explained that during her tenure at Vencor/Kindred in San Diego, California, a long term acute care facility, she routinely kept departmental statistics on dysphagia and weaning outcomes.

After formal implementation of a Passy-Muir Valve protocol, she and her administration noticed significant improvements in mean decannulation time and percentage of patients discharged on an oral diet. She felt strongly that the implementation of the Passy-Muir Valve as a standard of care played a significant role in these improved outcomes.

In 2006, while working at Scripps Memorial Hospital, Ms. Blumenfeld continued to observe significant and dramatic improvements in both swallowing and secretion management during fiberoptic endoscopic evaluations of swallowing (FEES) when the Passy-Muir Valve was utilized. In collaboration with her colleagues at Scripps Memorial Hospital and Dr. Peter Belafsky of UC Davis Medical Center, Sacramento, CA, she decided to formally study and document these changes.

She prospectively evaluated 21 tracheostomized patients with dysphagia. Patients were randomized into a speaking valve experimental group or tracheostomy tube only control group. All patients underwent four days of identical swallowing therapy. The experimental group wore the Passy-Muir Valve for 45 minutes a day and during therapy. All of the patients were evaluated with FEES on day 1 and day 4 with the experimental group having a Passy-Muir Valve during testing.

She evaluated swallowing severity using the Penetration Aspiration Scale (PAS) and secretion level changes using an ordinal secretion rating scale created for this study. The results of her study showed no differences in PAS or secretion ratings between days 1 and 4 for the control group (p>0.05). However, the PAS for the Passy-Muir Valve group improved from 3.67 to 1.75 (p<0.001) and the secretion rating improved from 2.91 to 1.55 (p<0.001).

Ms. Blumenfeld and colleagues concluded that the Passy-Muir Valve had a positive impact on swallowing function and secretion management. This study adds to the growing body of evidence for the use of the valve as a rehabilitation tool. Ms. Blumenfeld has submitted an abstract for the ASHA 2012 convention to share this data in a case study format. She explained that she has further interest in studying the positive effects of the Passy-Muir Valve and would like to specifically examine swallowing frequency of tracheostomized patients on the ventilator with and without the valve.

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