Stomal complications and airflow line problems of the communi‐trach I® cuffed talking tracheotomy tube

Leder, Steven B.; Astrachan, David I.

doi:10.1288/00005537-198902000-00012

Cited by 19 publications

(13 citation statements)

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“…Currently there are six types of specialized talking tracheostomy tubes available to allow communication with an inflated cuff [ 49 ]. The Portex Trach-Talk [ 36 , 39 , 42 ] and Communi-Trach I [ 42 , 56 ] were used with four case series. The Portex BLUSA Tracheostomy Tube was reported in one article with four case reports [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

“…These tracheostomy tubes have an additional lumen above the cuff through which air can flow into the larynx to facilitate verbal communication. Intelligible speech, measured by a subjective assessment of improvement of speech, was created in 100 % ( n = 20) [ 39 ] and 74 % ( n = 14) [ 36 ] using the Portex Trach Talk, in 90 % ( n = 18) with the Communi-Trach I [ 56 ], and in 79 % ( n = 15) using the Portex Trach-Talk and the Communi-Trach I (both or one of them were used) [ 42 ]. With the BLUSA tube, all patients ( n = 4) achieved adequate phonation [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

“…With the BLUSA tube, all patients ( n = 4) achieved adequate phonation [ 49 ]. It took an average of 2.1 days (Portex “Talk”) [ 39 ] and 5.6 days (Communi-Trach I) [ 56 ] before adequate voice intensity for intelligible speech was produced.…”

Section: Resultsmentioning

confidence: 99%

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Communicating with conscious and mechanically ventilated critically ill patients: a systematic review

et al. 2016

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BackgroundVentilator-dependent patients in the ICU often experience difficulties with one of the most basic human functions, namely communication, due to intubation. Although various assistive communication tools exist, these are infrequently used in ICU patients. We summarized the current evidence on communication methods with mechanically ventilated patients in the ICU. Secondly, we developed an algorithm for communication with these patients based on current evidence.MethodsWe performed a systematic review. PubMed, Embase, Cochrane, Cinahl, PsychInfo, and Web of Science databases were systematically searched to November 2015. Studies that reported a communication intervention with conscious nonverbal mechanically ventilated patients in the ICU aged 18 years or older were included. The methodological quality was assessed using the Quality Assessment Tool.ResultsThe search yielded 9883 publications, of which 31 articles, representing 29 different studies, fulfilled the inclusion criteria. The overall methodological quality varied from poor to moderate. We identified four communication intervention types: (1) communication boards were studied in three studies—they improved communication and increased patient satisfaction, but they can be time-consuming and limit the ability to produce novel utterances; (2) two types of specialized talking tracheostomy tubes were assessed in eight studies—audible voicing was achieved in the majority of patients (range 74–100 %), but more studies are needed to facilitate safe and effective use; (3) an electrolarynx improved communication in seven studies—its effectiveness was mainly demonstrated with tracheostomized patients; and (4) “high-tech” augmentative and alternative communication (AAC) devices in nine studies with diverse computerized AAC devices proved to be beneficial communication methods—two studies investigated multiple AAC interventions, and different control devices (e.g., touch-sensitive or eye/blink detection) can be used to ensure that physical limitations do not prevent use of the devices. We developed an algorithm for the assessment and selection of a communication intervention with nonverbal and conscious mechanically intubated patients in the ICU.ConclusionsAlthough evidence is limited, results suggest that most communication methods may be effective in improving patient–healthcare professional communication with mechanically ventilated patients. A combination of methods is advised. We developed an algorithm to standardize the approach for selection of communication techniques.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1483-2) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Communicating with conscious and mechanically ventilated critically ill patients: a systematic review

et al. 2016

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“…In addition, these tubes rely on use of the patient's own oral-pharyngeal mechanism [ 10]; allow speech throughout the whole of the respiratory cycle [1,11]; and permit maintenance of pre-set ventilator volumes and accurate monitoring of tidal volumes [ l ]. However, the disadvantages of "speaking tracheostomy tubes" are numerous: interference by secretions, difficulty in positioning the tube, problematic design of the tube, and altered voice quality [10, [12][13][14].…”

Section: Patientmentioning

confidence: 99%

Using ventilators for speaking and swallowing

Tippett

Siebens

1991

Dysphagia

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An inflated cuff, although commonly thought to be required for the ventilator-dependent patient with a tracheostomy cannula, precludes speaking and has adverse implications for swallowing. Clinical trials with five ventilator-dependent, cognitively intact individuals with glottic control document that a deflated cuff is compatible with ventilation, preserves oral communication, and restores safe alimentation by mouth.

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“…The drying effect, including the potential for laryngeal injury of continuous nonhumidified air running through the glottis, is also a potential problem area with above cuff vocalisation [83].…”

Section: Verbal Communication Options Suitable For Non-ventilated Andmentioning

confidence: 99%

Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

Sutt¹

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Tracheostomised mechanically ventilated patients are often left unable to speak, which is frustrating for patients and the staff caring for them. Having no voice causes major distress and feelings of helplessness for patients. Voicelessness frequently leads to reduced information exchange between the patient and healthcare team, frequently to the detriment of patient care. An in-line speaking valve (SV) is a one-way valve that may be used in the mechanical ventilation circuit to enable verbal communication in tracheostomised patients.Limited data exist regarding the effect of SVs on respiratory mechanics. Deflation of the tracheostomy cuff is required for placement of the SV, effectively causing a "leak" in the As an experienced speech pathologist, I believe concerns over SV use to date have little evidence. The main objective, and first aim of this thesis was to investigate the effect of SV use on respiratory mechanics to determine whether SVs should be used in-line with mechanical ventilation of tracheostomised patients. The second aim was to assess the effect of introducing SVs into a cardio-thoracic ICU on patient tracheostomy specific outcomes. The third aim was to further clarify the effect of SVs on success with healthrelated communication for ICU patients. To achieve these aims, 5 studies were conducted, resulting in 5 manuscripts.For the first aim, 20 tracheostomised ICU patients using a SV that met the inclusion criteria were recruited to the study from November 2013-December 2014. Electrical Impedance iii Tomography (EIT) was used to assess the patients' end-expiratory lung impedance (EELI) and ventilation distribution continuously over 60 minutes (before, during and after SV use). For the third aim, 25 patients and 52 nursing staff were asked to fill out a custom-made questionnaire on success with health communication, firstly when the patients were voiceless, and, secondly, when they were using a SV. Chapter 7 highlights individual differences and some disparity between patient and nursing ratings of communication success. Overall, however, following SV use both the patients and nursing staff reported a significant improvement in success with health communication. Additional variables included oxygenation (SpOIn conclusion, the findings of this thesis addressed the research aims, and provide new knowledge through use of an innovative approach to assessing lung mechanics. Having iv already resulted in real clinical changes in our centre, the results indicate the potential for optimising communication, using SVs in tracheostomised cardiothoracic ICU patients undergoing weaning from mechanical ventilation.v

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Stomal complications and airflow line problems of the communi‐trach I® cuffed talking tracheotomy tube

Cited by 19 publications

References 5 publications

Communicating with conscious and mechanically ventilated critically ill patients: a systematic review

Communicating with conscious and mechanically ventilated critically ill patients: a systematic review

Using ventilators for speaking and swallowing

Towards an improved understanding of the effect of a speaking valve on lung volumes and communication in the critically ill tracheostomised patient

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