IMPACT OF THE USE OF THE SPEECH VALVE ON THE SWALLOWING AND DECANULATION PROCESS

The speech valve can be safe and effective for tracheostomized, conscious patients with tolerance to deflated cuff. It can be coupled between 48 and 72 hours after tracheostomy, depending on the airway permeability. Objective: The objective of this study was to identify the impact of the use of the speech valve on adult patients hospitalized in the city of Campo Grande, in the state of Mato Grosso do Sul, aiming at swallowing, reintroduction of diet orally in a safe way and decannulation. Method: The longitudinal method with indirect and direct evaluation with PAP, PITA, PARD, BLUE DAY TEST, DECANULATION PROTOCOL AND SCALE was used in adult and hospitalized patients. Results: Regarding the criterion of time for decannulation, after the beginning of the training with the speech valve, we consider the following findings. All patients decannulated within a maximum of 15 days after the use of the speech valve. All started oral feeding in a maximum of 7 days after using the speech valve. And SNE was removed in all patients within 15 days after using the speech valve. There is evidence that the use of the speech valve has positive impacts on the swallowing process, reintroduction of the diet orally in a safe way and on the decannulation process. Conclusion: It was concluded that the use of the speech valve brought benefits to patients, in addition to facilitating the phonation process and the adjustment of the respiratory pattern closer to the physiological one before decannulation has an importance in swallowing and a decrease in the time of swallowing. Decannulation.

Person in Need of Airway Cleaning and Use of Mechanical Insufflator-Exsufflator

Clearing of the airways in patients undergoing invasive mechanical ventilation (IMV) or non-invasive mechanical ventilation (NIMV) is a fundamental intervention that should be performed regularly, not only to avoid accumulation of secretions, but also to prevent the accumulation of secretions. One of the most relevant interventions in this type of patients is the use of the mechanical insufflator-exsufflator (MI-E), commonly known as cough assist. On the other hand, respiratory functional reeducation (RFR) involves a set of non-invasive procedures that allow the secretion to be released. The efficacy of the RFR associated with the use of MI-E presents gains resulting from this conjugation, namely when the person does not cooperate, when he/she shows a decrease in muscle strength or fails to present an effective cough. The integrative review of the literature has made evident the gains that exist for the person in intensive care, using MI-E associated with airway clearance, ventilation performance, airway permeability, decreased complications, and rate mortality.

Nursing outcome “airway permeability” in postoperative patients

ABSTRACT Objectives: to evaluate the evolution of clinical indicators that characterize airway permeability in patients in the postoperative period of thoracoabdominal surgeries and to analyze their relationship with the occurrence of the diagnosis “ineffective airway clearance”. Methods: descriptive, quantitative, longitudinal research with 60 patients who were followed for five consecutive days. Eleven indicators of the nursing outcome “respiratory status: airway permeability” were used. Results: on the first day of evaluation, the most compromised indicators were: respiratory rate, cough, depth of breath and use of accessory muscles. During follow-up, most of the indicators presented a slight deviation from normal variation and, in the last evaluation, there was a predominance of indicators with some degree of impairment. Conclusions: with the aid of the Nursing Outcomes Classification, it was observed that patients submitted to thoracoabdominal surgeries may present compromised airway permeability even days after surgery.

Airway and alveolar permeability and surface liquid thickness: theory

Widdicombe, John. Airway and alveolar permeability and surface liquid thickness: theory. J. Appl. Physiol. 82(1): 3–12, 1997.—The thickness of airway surface liquid (ASL) can be calculated as the ratio of the permeability coefficient of an absorbed inert tracer to the percentage rate in which it decreases in content in the airway lumen. The percentage clearance of radiolabeled diethylenetriaminepentaacetic acid (DTPA) from human airways or lungs has been measured many times, with a mean value of 1.04 ± 0.25 (SD) %/min. Rates of clearance from animal lungs of most species give values of the same order, although they are lower in the sheep and higher in the dog. Permeability coefficients have not been measured simultaneously with percentage clearances and not at all for human tissues. Values for mannitol and sucrose, of which the former gives a permeability coefficient ∼25% greater than that for sucrose and DTPA in airway tubes and isolated mucosal sheets from experimental animals, give a mean of ∼7.1 × 10−7 cm/s. This corresponds to thicknesses of ASL of ∼20–150 μm for various species. The assumptions underlying this estimate are discussed. It is concluded that ASL thickness in vivo may be considerably greater than in vitro measurements involving rapid freezing of the airway wall. Estimates of alveolar permeability suggest that either it is very considerably lower than that of the airway epithelium, that methods to measure alveolar permeability mainly reflect airway permeability, or both.

Acute ozone-induced change in airway permeability: role of infiltrating leukocytes

The role of infiltrating polymorphonuclear leukocytes (PMNs) in acute lung injury and inflammation is still controversial. In inbred mice, acute ozone (O3) exposure induces airway inflammation that is characterized by a maximal influx of lavageable PMNs 6 h after exposure and a maximal increase in lung permeability 24 h after O3. We tested the hypothesis that O3-induced change in airway epithelial permeability of O3-susceptible C57BL/6J mice is due to infiltrating PMNs. Male mice (6–8 wk) were treated with a nonsteroidal anti-inflammatory drug (indomethacin), a chemotactic inhibitor (colchicine), or an immunosuppressant (cyclophosphamide) to deplete or inhibit PMNs from infiltrating the airways. After drug or vehicle treatment, mice were exposed for 3 h to 2 ppm O3 or filtered air, and pulmonary inflammation was assessed by inflammatory cell counts and total protein content (a marker of airway permeability) in bronchoalveolar lavage (BAL) fluid. Filtered air exposure did not affect the parameters of pulmonary inflammation at any time after exposure. Compared with vehicle controls, each of the drug treatments resulted in significant reduction of PMN influx 6 and 24 h after O3. However, total BAL protein content was not attenuated significantly by the three treatments at either 6 or 24 h postexposure. Results of these experiments suggest that the influx of PMNs and the change in total BAL protein are not mutually dependent events in this model and suggest that infiltrating PMNs do not play a major role in acute O3-induced changes in permeability of the murine lung.