Tracheostoma valves and their associated risks

Abstract

Tracheostoma valves have proven to be very effective for voice restoration in patients with a tracheotomy or laryngectomy. Nevertheless, in recent years there have been a number of reports about life-threatening incidents with tracheostoma valves. An analysis of these incidents and the commercially available tracheostoma valves, their functions and limitations enables typical risk situations to be derived. The most reported incidents were caused by inadvertently filling the cuff of the tracheostomy tube while the tracheostoma valve was in place and by confusing a heat and moisture exchanger (HME) filter with a tracheostoma valve. These mistakes caused a complete obstruction of the expiratory airway leading to a barotrauma of the lungs with pneumothorax and asphyxia. Another typical risk in mechanically ventilated patients is insufficient monitoring during the use of the tracheostoma valve. Clear marking of tracheostoma valves and a specific training of hospital personnel with respect to the typical risks of tracheostoma valves could effectively reduce the associated dangers.