title: Experimental Assessment and Future Applications of the Shikani Tracheostomy Speaking Valve.
abstract: OBJECTIVE
  Tracheostomy speaking valve use may increase airflow resistance and work of breathing. It remains unclear which valve offers the best performance characteristics. We compared the performance characteristics of the Shikani speaking valve (SSV; unidirectional-flow ball valve) with those of the Passy-Muir valve (PMV; bias-closed flapper valve).
  
  
  METHODS
  Airflow resistance was measured for both the SSV and the PMV at 8 flow amplitudes and in 3 orientations (-15°, 0°, +20°) in the bias-open and bias-closed configurations.
  
  
  RESULTS
  Significantly lower airflow resistance was observed for the SSV (bias open) compared with the PMV at -15° (p < .001), 0° (p < .001), and +20° (p = .006) from the horizon. No significant difference was observed between the PMV and the SSV (bias-closed) configuration at any of the tested angles. A nonsignificant trend toward decreased airflow resistance was observed between the SSV bias-open and bias-closed configurations at each of the angles tested.
  
  
  CONCLUSIONS
  The SSV demonstrated lower airflow resistance compared with the PMV across 8 flow amplitudes in the bias-open configuration at -15°, 0°, and +20° from the horizon. Further investigation is needed to determine the clinical impact of these findings on patient comfort, work of breathing, phonation, and airway protection during swallowing.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Shikani
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Miller
authors.forename: Elamin M
authors.initials: EM
authors.lastname: Elamin
mesh_terms: D000403:Airway Resistance; D004867:Equipment Design / Q000639:trends; D005544:Forecasting; D006801:Humans; D007831:Larynx, Artificial / Q000639:trends*; D010699:Phonation; D018467:Positive-Pressure Respiration, Intrinsic; D012123:Pulmonary Ventilation; D012131:Respiratory Insufficiency / Q000628:therapy; D014139:Tracheostomy / Q000295:instrumentation* / Q000639:trends*; D014939:Work of Breathing