Patients with a conventional tracheostomy tube can’t speak because the cuffed tracheostomy tube that directs air into the lungs on inspiration expels air through the tracheostomy tube rather than the vocal cords, mouth, and nose. Providing a means of communication for such patients is crucial for their physical and emotional well-being. Nonverbal means of communicating, such as writing, lip-reading, alphabet boards, and gestures, can be frustrating for the patient and family members as well as for health care facility personnel. Until recently, the only alternatives were cuffed tracheostomy speaking tubes and the use of an artificial larynx.

The Passy-Muir Tracheostomy and Ventilator Speaking Valve (PMV) allows the ventilator-dependent patient to speak. The PMV is a positive-closure, one-way speaking valve developed by David Muir (a ventilator-dependent patient). It opens upon inspiration to allow the patient to inspire through the tracheostomy tube and then closes after inspiration, redirecting the exhaled air around the tube, through the vocal cords, and out of the mouth.

Other speaking valves, such as the Montgomery Ventrach, the Shiley Phonate, and a variety of others, have since been developed. Some have a closed valve like the PMV, whereas others have valves containing an alternate design.¹

Ideally, the tracheostomy should be cuffless; however, if you’re using a cuffed tube, the tracheostomy cuff must be completely deflated to enable the patient to exhale and to function safely.¹ For maximum airflow around the tube, the tube should be no larger than two-thirds the size of the tracheal lumen.

The PMV 005 is most commonly used by nonventilated tracheostomy patients, but it can be used by ventilator patients with rubber, nondisposable ventilator tubing. The PMV 007 fits easily into the ventilator tubing used by mechanically ventilated tracheostomy patients.¹ Both valves fit the 15-mm hub of adult, pediatric, and neonatal tracheostomy tubes and can be used by patients either on or off the ventilator.

Two other PMV valves are available: the PMV 2000 and the PMV 2001. Both of these valves are low-profile and low-resistance, feature the positive-closure design, and can be used on or off the ventilator. The PMV 2000 is clear in color and is used more readily in the home care setting because it’s less noticeable. The PMV 2001 is a bright purple color and is used more often in health care facility settings because the color is more noticeable. These valves also include safety ties that prevent valve loss if the patient inadvertently coughs the PMV out of the tracheostomy tube.

A PMV oxygen adapter is now available for use with the PMV 2000 series speaking valves. This adapter allows improved mobility and comfort for patients who require a tracheostomy tube, speaking valve, and low-flow supplemental oxygen.

Short- and long-term adult, pediatric, and infant tracheostomy and ventilator-dependent patients may benefit from the use of a PMV.

PMV use is contraindicated in patients with severe tracheal or laryngeal stenosis, laryngectomy, or excessive oral secretions and in patients who are unconscious or at risk for aspiration.¹,²

PMV use requires a multidisciplinary team approach. A doctor’s order is required for placement of the PMV and sometimes for cuff deflation. The nurse and the respiratory therapist monitor and assess the patient while he’s using the PMV. The respiratory therapist makes ventilator adjustments for the ventilator-dependent tracheostomy patient. A speech-language pathologist should assess the patient’s cognitive, language, and oral motor function and may also evaluate swallowing status and risk for aspiration. The patient must also be involved in the decision to use the PMV.

An initial trial assesses the patient’s tolerance. During this trial period, the nurse should make sure the patient understands how the PMV functions and what to expect during the trial. If he’s anxious, especially during cuff deflation, he may be unwilling to use the valve, so he’ll need emotional support. The patient shouldn’t be left unsupervised with the valve in place until tolerance is determined.¹

If the patient can’t tolerate the PMV initially, the team should troubleshoot to determine the cause. The problem can usually be easily remedied (for example, by repositioning the patient, downsizing the tracheostomy tube, changing to a cuffless tube, or correcting an airway obstruction). Some patients will only be able to wear the PMV for a few minutes at a time, building up time gradually, as tolerated.

If repeated trials fail, the speech-language pathologist should assess the patient for other communication options.