Benefits and options for voice restoration in mechanically ventilated intensive care unit patients with a tracheostomy

Abstract

Communication difficulties and their effects on patients who are mechanically ventilated are commonly reported and well described. The possibility of restoring speech for patients has obvious benefits, not only for meeting patient’s immediate needs, but for helping them to re-engage in relationships and participate meaningfully in their recovery and rehabilitation. This opinion piece by a group of United Kingdom (UK) based Speech and Language Therapy experts working in critical care describes the various ways by which a patient’s own voice can be restored. Common barriers to using different techniques and potential solutions are explored. We therefore hope that this will encourage intensive care unit (ICU) multi-disciplinary teams to advocate and facilitate early verbal communication in these patients.

High‐flow via a tracheostomy tube and speaking valve during weaning from mechanical ventilation and tracheostomy

“…However, a tracheostomy tube with an inflated cuff negatively impacts saliva management and swallowing 3,4 in addition to leaving the patient without a voice 3,4 . By deflating the cuff and using a one‐way valve (OWV), also known as a speaking valve, expiratory flow through the upper airway is restored and pharyngeal and laryngeal rehabilitation necessary for tracheostomy weaning 4–6 may commence in parallel to weaning from mechanical ventilation 4–6 …”

Early versus late tracheostomy: what do patients want?

“…It is therefore apparent that for the patient’s upper airway to benefit from an early tracheostomy rehabilitation must commence as soon as possible [ 7 ]. The optimal and most natural option is by using a one-way valve [ 7 – 9 ].…”

“…It is therefore apparent that for the patient’s upper airway to benefit from an early tracheostomy rehabilitation must commence as soon as possible [ 7 ]. The optimal and most natural option is by using a one-way valve [ 7 – 9 ]. If that is not feasible for some reason, then enabling some airflow by using above cuff vocalisation [ 7 , 10 , 11 ] is the next best option.…”

“…The optimal and most natural option is by using a one-way valve [ 7 – 9 ]. If that is not feasible for some reason, then enabling some airflow by using above cuff vocalisation [ 7 , 10 , 11 ] is the next best option. Third, although with its limitations, is leak speech [ 7 ].…”

“…If that is not feasible for some reason, then enabling some airflow by using above cuff vocalisation [ 7 , 10 , 11 ] is the next best option. Third, although with its limitations, is leak speech [ 7 ]. All these methods, when used after a thorough upper airway patency assessment [ 12 ], have shown to safely restore the airflow via the patient’s upper airway, enabling the use of voice and facilitating oral intake.…”