Exercise in patients with a tracheostomy and speaking valve: a randomised crossover-controlled trial

Luke Churchill, Lawrence Caruana, Nicole White, John F. Fraser, Allison Mandrusiak, Jennifer Paratz, Anna-Liisa Sutt, Peter J. Thomas, Stacey Verner-Wren & Oystein Tronstad. Crit Care 29, 368 (2025). doi.org/10.1186/s13054-025-05621-2

Critically ill patients expected to receive prolonged invasive mechanical ventilation commonly receive a tracheostomy. Whilst a tracheostomy reduces sedation requirements and improves comfort, mobility, and communication, it is often associated with prolonged intensive care unit (ICU) and hospital length of stay. These patients require exercise and rehabilitation which have well documented benefits in critical illness. A speaking valve (SV) may be used to facilitate verbal communication and improve lung recruitment; however, is often removed during exercise due to potential (but unsubstantiated) safety concerns such as lung de-recruitment. While the safety and benefits of SVs have been demonstrated with patients resting in bed, no studies have examined their impact during exercise. The aim of this study was to investigate the effect of performing exercise with a SV on lung function.