The use of the Passy Muir Valve with COVID-19 Veno-Venous Extra Corporeal Membrane Oxygenation patients;a case series

Introduction: Our Trust is a large academic and Veno-Venous Extra Corporeal Membrane Oxygenation (VV ECMO) national centre. During the first COVID-19 surge, our centre supported 35 patients using VV ECMO. This case series details the use of the Passy Muir one-way speaking valve (PMV) with four COVID-19 patients on VV ECMO;a new practice at our centre. Objectives: To describe: 1. Using the PMV in-line with the ventilator circuit with COVID-19 patients on VV ECMO. 2. Benefits, risk assessment and patient experience. 3. Implications on the Physiotherapy service. Methods: The notes of the four patients were reviewed retrospectively to collect data as per tables one and two. In line with the Trust PMV guidelines, the four patients who used the PMV were assessed by a Physiotherapist. A risk assessment was completed prior to each session which included: cardiovascular stability, staff competence and discussion with the Critical Care Area (CCA) Multi-Disciplinary Team (MDT). The PMV is a high-risk device. In accordance with the Trust PMV guidelines, a Physiotherapist led each session and stayed with the patient throughout. This reduced the risks associated with using the PMV in an area where few staff had been trained. Results: Patient feedback included decreased work of breathing and appreciation for being able to speak with family. Two patients were able to engage with the CCA MDT to make decisions about their care. Following joint Physiotherapy and Speech and Language Therapy assessment two patients, including one who underwent Fiberoptic Endoscopic Evaluation of Swallowing (FEES), were safe to have oral intake whilst on the PMV. Oral intake whilst ventilated via tracheostomy was not possible at our centre prior to the introduction of the PMV. Twenty out of a total of 42 PMV sessions were stopped due to lack of Physiotherapist time;the most common reason for ending a PMV session. Two sessions were stopped due to coughing and seven due to patient request. There were four episodes of adverse events during a total of 42 PMV trials;two episodes of hypotension and two episodes of coughing. On each occurrence the PMV trial was stopped and the patient recovered. Conclusion: The use of the PMV with these four COVID-19 patients on VV ECMO proved safe and effective. It facilitated patient centred care by supporting communication and enabling oral intake. There were instances where patients were unable to use PMV due to demands on Physiotherapy time and availability. Additional training is required for senior CCA nurses to be competent using the PMV. Further data collection is required to fully understand the impact, safety and effectiveness of the PMV with this patient group but initial results are encouraging.

Patients With Voice Prosthesis Rehabilitation During the COVID-19 Pandemic: Analyzing the Effectiveness of Remote Triage and Management.

OBJECTIVE: To describe a remote approach used with patients with voice prosthesis after laryngectomy during the COVID-19 pandemic and the resulting clinical outcomes in terms of voice prosthesis complications management, oncological monitoring, and psychophysical well-being. STUDY DESIGN: Prospective cohort study. SETTING: Otolaryngology Clinic of the University Polyclinic A. Gemelli, IRCCS Foundation. SUBJECTS AND METHODS: All patients with voice prosthesis who underwent laryngectomy followed by our institute were offered enrollment. Patients who agreed to participate were interviewed to inquire about the nature of the need and to plan a video call with the appropriate clinician. Before and 1 week after the clinician's call, patients were tested with the Hospital Anxiety and Depression Scale. Degrees of satisfaction were investigated with a visual analog scale. A comparison between those who accepted and refused telematic support was carried out to identify factors that influence patient interest in teleservice. RESULTS: Video call service allowed us to reach 37 (50.68%) of 73 patients. In 23 (62.16%) of 37 cases, the video call was sufficient to manage the problem. In the remaining 14 cases (37.83%), an outpatient visit was necessary. Participants who refused telematic support had a significantly shorter time interval from the last ear, nose, and throat visit than patients who accepted (57.95 vs 96.14 days, P = .03). Video-called patients showed significantly decreased levels of anxiety and depression (mean Hospital Anxiety and Depression Scale total score pre- vs post-video call: 13.97 vs. 10.23, P < .0001) and reported high levels of satisfaction about the service. CONCLUSION: Remote approach may be a viable support in the management of patients with voice prosthesis rehabilitation.

Tracheoesophageal voice prosthesis management in laryngectomy patients during the COVID-19 pandemic.

With the COVID-19 pandemic, there has been significant changes and challenges in the management of oncology patients. One of the major strategies to reduce transmission of the virus between patients and healthcare workers is deferral of follow-up visits. However, deferral may not be possible in total laryngectomy patients. Urgent procedures may be necessary to prevent complications related to ill-fitting tracheoesophageal puncture (TEP) voice prostheses, such as aspiration or loss of voicing. In this paper, we describe the Princess Margaret Cancer Center's approach to managing this unique patient population.