Sudden appearance of neck and face emphysema during above cuff vocalisation

Calamai, Italo; Giuntini, Romano; Tomeo, Francesco; Spina, Rosario

doi:10.1007/s00134-018-5233-6

Cited by 6 publications

(17 citation statements)

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“…Most of the included studies were non randomised, observational studies, of which three were prospective observational studies involving 50 patients, 6,12,13 six observational studies without further specification of design involving 90 patients, 8,9,14-17 and six case studies involving 16 patients. 7,[18][19][20][21][22] Two randomised controlled clinical trials (RCT) with 75 patients assessing QOL related to the effect of ACV on speech were also included (Table 1). 20,23 Age of patients, when reported, ranged from 14 to 83 years.…”

Section: Characteristics Of Sources Of Evidencementioning

confidence: 99%

“…20,23 Age of patients, when reported, ranged from 14 to 83 years. 6,7,[12][13][14][15][16][17][18][19][21][22][23][24] F I G U R E 2 Flow diagram of the study selection procedure…”

Section: Characteristics Of Sources Of Evidencementioning

confidence: 99%

“…Overall, 115/131 (88%) patients in the 14 studies reporting patient numbers were able to communicate with an audible voice or whisper using ACV, ranging from 50% to 100% in the individual studies. [6][7][8][12][13][14][15][16][17][18][19]21,22,24 McGrath et al (2019) reported speech or whisper in 66/91 (72,5%) ACV-episodes. 6 Safar and Grenvik (1975) reported…”

Section: Effect On Speechmentioning

confidence: 99%

“…14 Airflow ranged from 1 to 15 l/min, and both compressed oxygen and air were used. [6][7][8][9]12,13,[15][16][17][18][19][20]22,24 Overall, 16 patients were unable to speak with ACV and the reasons were reported in nine out of these 16 patients. Reported reasons included permanent laryngeal injury due to inhalation/burns and trauma (one), 7 severe flaccid dysarthria (one), 24 tracheal air leak (one), 8 vocal cord paralysis (two), 15,17 excessive secretions (one), 15 granulation tissue between the vocal cords (one) 17 and unspecified laryngeal pathology (two).…”

Section: Effect On Speechmentioning

confidence: 99%

“…Two adverse events were reported in two patients. 18,22 Subcutaneous emphysema occurred in a patient with a malpositioned tracheostomy tube where the suction port was located outside the tracheal lumen, allowing gas flow to spread subcutaneously. 18 Tracheal distention was reported in a case where continuous airflow was incorrectly connected to the cuff line, resulting in cuff rupture and tracheal distention.…”

Section: Safetymentioning

confidence: 99%

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Above cuff vocalisation (ACV): A scoping review

Petosic

Viravong

Martin

et al. 2020

Acta Anaesthesiol Scand

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Introduction Patients in intensive care frequently suffer from not being able to communicate verbally. The aim of this scoping review was to study the safety and effectiveness of the above cuff vocalisation (ACV) on speech and quality of life (QOL) in patients dependent on a cuffed tracheostomy. Methods A scoping review was conducted. The databases Ovid Medline, Cochrane Library, and Embase were systematically searched in May 2020. We included clinical studies with patients exposed to ACV where speech, QOL or safety issues were assessed. Results Overall, 17 studies were included, of which 15 were observational and 2 were randomised controlled trials. Totally, 231 patients were included. ACV enabled most of the included patients (115/131; 88%) to speak with an audible voice or whisper (moderate quality of evidence). Voice related QOL (V‐RQOL) and QOL in mechanically ventilated patients (QOL‐MV) improved from pre‐ to post‐ ACV compared to a control group not tolerating a one‐way speaking valve (P = .01 and P = .04, respectively) (very low quality of evidence). Several minor complications or problems were reported in 20/75 (27%) cases in addition to two serious adverse events: subcutaneous emphysema in one patient where the tracheostomy was dislodged and a distended trachea in another due to the misconnection of continuous gas to the cuff (low/ very low quality of evidence). Conclusion ACV facilitated communication in patients dependent on a cuffed tracheostomy and attempting to communicate. Quality of evidence in improved V‐RQOL and QOL‐MV was very low. Several minor complications and two serious adverse events were reported.

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Section: Characteristics Of Sources Of Evidencementioning

confidence: 99%

“…20,23 Age of patients, when reported, ranged from 14 to 83 years. 6,7,[12][13][14][15][16][17][18][19][21][22][23][24] F I G U R E 2 Flow diagram of the study selection procedure…”

Section: Characteristics Of Sources Of Evidencementioning

confidence: 99%

Section: Effect On Speechmentioning

confidence: 99%

Section: Effect On Speechmentioning

confidence: 99%

Section: Safetymentioning

confidence: 99%

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Above cuff vocalisation (ACV): A scoping review

Petosic

Viravong

Martin

et al. 2020

Acta Anaesthesiol Scand

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Evidence for Above Cuff Vocalization in Patients With a Tracheostomy: A Systematic Review

et al. 2021

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Objectives/Hypothesis: To determine how above cuff vocalization (ACV) is implemented in clinical practice, to identify what evidence exists on the effectiveness and safety of ACV, and to evaluate the acceptability of ACV.Study Design: Systematic review. Methods: A literature search was conducted in eight databases (MEDLINE, Embase, AMED, CINAHL, Cochrane Library, PsycINFO, Scopus, and Web of Science) in May 2019 and updated in June 2020. Two reviewers independently screened, selected, and extracted data. Study quality was appraised using the Joanna Briggs Institute Critical Appraisal Tools and a narrative synthesis was conducted. Systematic review registration number: CRD42019133942.Results: The searches identified 1327 records. The 13 eligible studies included four case studies, three case series, four observational studies without a control group, one quasi-experimental study, and one randomized controlled trial. Study quality was low, with most studies having high risk of bias. There was a high level of heterogeneity in study design and outcome measures used. Detailed information on ACV application and dose-delivered was lacking in 12 studies. Positive effects were reported for communication (n = 7), swallowing (n = 4), cough response (n = 2), and quality-of-life (n = 2), but with inconsistent use of objective outcome measures. There is limited quantitative or qualitative evidence for acceptability. Adverse events and complications were reported in nine studies, and four highlighted the importance of involving an experienced speech and language therapist.Conclusions: There is limited evidence for the acceptability, effectiveness, safety, or optimal implementation of ACV. The evidence is insufficient to provide recommendations regarding optimal intervention delivery. Future research should ensure detailed recording of ACV delivery and utilize a core outcome set.

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Determining the Prevalence, Implementation Approaches, and Opinions of Above Cuff Vocalization: A Survey of Health Care Professionals

Mills

Michou

Bellamy

et al. 2022

Archives of Physical Medicine and Rehabilitation

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To conduct an international survey to investigate the use of above cuff vocalization (ACV) and how practice and opinion differs. Design: Observational, cross-sectional online survey. Setting: Critical care, acute, rehabilitation, long-term care, and community. Participants: Health care professionals involved in tracheostomy care or weaning (N=243). Interventions: Not applicable. Main Outcome Measures: Tracheostomy management, prevalence, personal experiences and opinions, and barriers to use. Quantitative data were reported descriptively, and content analysis was conducted with qualitative data. Results: The survey was completed by 243 health care professionals from 9 professional groups and 25 countries, with most responses from the United Kingdom (54%) and speech and language therapists (55%). ACV was used in 39% of services (n=93). Sixty percent (n=50/83) of health care professionals with direct experience of ACV had used it with <10 people. Implementation of ACV varied widely concerning procedures, contraindications, safety processes, professionals involved, competencies, staff training, delivery, and outcome measures. The top benefits were communication (n=76/93; 82%), mood (n=62/93; 67%), and laryngeal sensation (n=49/93; 53%). Complications included discomfort (n=54/93; 58%) and strained vocal quality (n=39/93; 42%). Barriers to ACV implementation included lack of knowledgeable staff (n=92/238; 39%) and lack of access to training (n=73/238; 31%). Conclusions: ACV uptake varies internationally with no standardized approach to ACV delivery. Diversity of opinions on approaches and benefits exist. Serious complications are infrequent, but minor complications are common. Future research is needed to establish optimal ACV implementation to maximize benefits and minimize risks.

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Sudden appearance of neck and face emphysema during above cuff vocalisation

Cited by 6 publications

References 0 publications

Above cuff vocalisation (ACV): A scoping review

Above cuff vocalisation (ACV): A scoping review

Evidence for Above Cuff Vocalization in Patients With a Tracheostomy: A Systematic Review

Determining the Prevalence, Implementation Approaches, and Opinions of Above Cuff Vocalization: A Survey of Health Care Professionals

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