Can Patients Safely Exercise With a Speaking Valve in Place?
Abstract: This randomized crossover-controlled study evaluated 20 ICU patients with tracheostomies performing in-bed cycle ergometry with versus without a speaking valve (SV). Safety was assessed via lung aeration using electrical impedance tomography (EIT), vital signs, and patient experience.
Key Insights:
- Safety: No adverse events occurred in either group. SpO₂ remained >96% and HR <100 bpm throughout.
- Lung aeration: Both groups showed reduced aeration during exercise, but loss was smaller and recovery greater with SV in situ.
- Tidal variation: Increases were significantly larger with SVs, suggesting better ventilation distribution.
- Patient preference: 83% preferred exercising with SVs, citing improved ability to communicate needs and ask questions.
- Performance: Exercise tolerance was similar with or without SV, indicating no physiologic downside to SV use.
Why This Matters: Patients with tracheostomies often have SVs removed during exercise due to safety concerns. This study demonstrates SV use during exercise is safe, improves lung recruitment, and enhances communication.
Conclusion: Tracheostomized patients can safely exercise with SVs in place, benefiting both physiology and autonomy.
Take-Home for Clinicians:
- Keep SVs in place during ICU exercise unless contraindicated.
- Expect improved lung aeration and communication with no added risk.
- Incorporate SV-assisted exercise into ICU rehabilitation protocols.
Discussion Question: Should SVs become the default standard for exercise in tracheostomized ICU patients to maximize both safety and engagement?
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